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Dayton, Ohio, Paramedicine Program Reduces ER Visits

To avoid overburdening hospitals, the program enrolls chronically ill patients whose health-care options have been limited to emergency room visits, and provides them tools to care for themselves without calling 911.

by Jim McKay / November 6, 2020
AP

Emergency rooms across the country are often overrun, and that puts a heavy burden on the health-care system. Often the folks who call 911 and have to be transported are repeat offenders. They may have no health-care plan, and without the wherewithal or resources to take care of themselves, going for a doctor visit means going to the emergency room, perhaps via 911 transport.

The community paramedicine program in Dayton, Ohio, was created just for this reason. Just before it started last year, the tally of trips to the emergency room from a few individuals was staggering. Just 166 people accounted for 5,000 visits to the emergency room in the Dayton area. About 30 percent of those ER visits were via 911 call.

The paramedicine program, created by Premier Health and the Dayton Fire Department aims to target those individuals, specifically those with 20 or more visits to the emergency room in a 12-month period, and get them the help they need and the tools required to address their health issues without continually going to the emergency room.

“We found that these are people who were not coming in to the emergency department for a hangnail,  but who had chronic health conditions and were functioning in crisis mode, where they’d go along and then they’d have an issue,” said Candy Skidmore, Premier Health vice president, service line integration, emergency and trauma.

“They’d have an issue, maybe with diabetes, high blood pressure or a heart problem, come in, get stabilized, and either go home from the ED or get hospitalized, be good for a while, then be back again,” she continued.  

The community paramedicine program enrolls 15 to 20 patients per month and aims to “graduate” them within 60 to 90 days. Graduation means equipping the patients to handle whatever health-care crisis that is prompting the visits to the ER, and those often coincide with a social situation that is exacerbating an illness.

“We’re obviously looking at their medical condition, but also their social situation — are they in an abusive relationship, do they have nutrition, are they living in a place that’s safe and warm?” Skidmore said. “These folks have a long assessment checklist.” 

Program success is measured by whether these individuals are still having to call 911 and/or ending up in the ER for treatment. Since about December of last year, there has been a marked decrease in visits to the emergency room. 

“We looked at the 12 months before our [first] group of patients went through the program and then looked post and found that we have reduced visits by slightly more than 80 percent,” Skidmore said.

“The goal is if you provide the education, you teach people to recognize that their congestive heart failure is starting to act up because they’re eating too much salt or they’re not managing their weight.” 

Potential participants undergo an assessment from the two-person team and also a social worker, who look at the factors that are leading to these individuals ending up in the ER. Do they need help with food, paying bills, finding a doctor or paying for prescriptions? The team will help with all of those situations.  

The program is sponsored by Premier Health and limited to the city of Dayton, but expansion is a possibility and some insurance companies have taken notice and expressed an interest in possibly helping with funding in the future.  

“Premier Health partnered with us and provided the capital, the vehicle [an SUV] and the major equipment,” said Andrew Braun, assistant fire chief for the Department of Fire Support Services and Resource Management.  “We have provided one EMT and one paramedic, both of whom have been on the job for about 10 years.”

Braun said crewmembers make referrals within the Dayton neighborhoods in which they work, and that the program could expand outside the city in the near future. 

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