Abstract 14280: Can Telemedicine-Assisted Paramedicine Reduce Emergency Department Visits and 30-Day Readmissions Among High-Risk Heart Failure Patients? a Pilot Study

• Published in: Circulation (New York, N.Y.) Vol. 138; no. Suppl_1 Suppl 1; p. A14280
• Main Authors: Daniels, Brock, Del Toro, Cristina, Zelenetz, Michael, Gogia, Kriti, Hafeez, Baria, Greenwald, Peter, Clark, Sunday, Steel, Peter, Hsu, Hanson, Goyal, Parag, Horn, Evelyn, Sharma, Rahul
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 06.11.2018
• ISSN: 0009-7322; 1524-4539

IntroductionHeart failure (HF) patients have high rates of 30-day readmission and emergency department (ED) utilization. Early physician contact within 7 days of discharge is optimal, but successful implementation has been limited by barriers such as appointment availability, low show rates and patient transport.HypothesisTelemedicine-assisted paramedicine (TAP) is a feasible and acceptable intervention for HF patients at high risk for readmission.MethodsTAP involves specially-trained HF paramedics performing home visits with ED physicians providing video tele-medical oversight using tablets and wireless hotspots. Home evaluations consist of an exam, ECG, point of care labs and medication reconciliation. Medics can administer IV medications and ED physicians can consult simultaneously with HF cardiologists. We describe the pilot cohort, interventions performed, patient satisfaction and hospital readmissions. Observed 30-day readmission rates were compared to predicted rates based on an internally-validated, machine-learning algorithm developed to identify HF patients at high-risk for readmission.ResultsDuring the 6-month pilot study, 36 patients were identified and 15/26 (66%) were enrolled. The mean age was 67, 53% were female, 53% were Black, 20% Hispanic and 20% White. Half of enrollees had a home health aid and 33% lived alone. Forty TAP home visits were performed (mean=2.5 visits/patient, range1-9) a mean of 5 days after discharge. Diagnostics or medical interventions were performed in 55% and 11% of visits, respectively. One or more medication discrepancies were identified in 47% of visits; 34% of visits resulted in medication adjustments. One admission (6.7%) occurred within 30 days of discharge among enrolled patients. The observed readmission rate among all HF patients was 29%, and 48% among those predicted by the model to return; 9/15 enrolled patients were predicted to return. Patient satisfaction was high. Patient-reported measures of engagement and understanding of medications suggest improvement post-enrollment.ConclusionsThe telemedicine-assisted paramedicine program is feasible and acceptable. Results suggest TAP can reduce 30-day readmissions and improve patient-reported outcomes.We are currently designing a stepped-wedge implementation to conduct a comparative- and cost-effectiveness study of TAP at several sites within our health system