I have come to the conclusion that we need to rethink the mission of hospitals and have blogged about the impetus toward decentralization that is causing various types of healthcare to be delivered closer to patients' homes (see: Merged CVS and Aetna Will Move Toward a Community-Based Healthcare Model; The Changing Role of Clinical Pathologists; Analogy with Hospital Pharmacists; TEN MAJOR TRENDS FACING THE HEALTHCARE INDUSTRY IN THE AMBULATORY SPACE ON A FIVE-YEAR HORIZON). Part of this trend is exemplified by the emergence of the so-called bedless hospital (see: The Future of Healthcare: Virtual Physician Visits & Bedless Hospitals; The Design of Bedless Hospitals Continue to Evolve Based on Cost and Technology; Some Additional Ideas About the Bedless Hospitals of the Future). Part of this trend also involves the increasing popularity of virtual care (i.e., telemedicine) (see: Telemedicine and Home Monitoring Will Promote Healthcare Transformation; Surgeons Extol the Advantage of Telemedicine in Rural British Columbia; The Need for More Research in Provider-to-Provider Telemedicine). New ideas about pushing care out of hospitals and into the community continue to blossom. A recent article raised the issue of community paramedicine (see: Do Hospitals Still Make Sense? The Case for Decentralization of Health Care). Below is an explanation of this model of decentralized care:
Decentralization is also being achieved through the use of well-trained health care providers on wheels: paramedics and emergency medical technicians in ambulances. This ready-made army of mobile health clinics has been used to create a new category of care delivery known as community paramedicine. The Geisinger Health System in Pennsylvania calls its community paramedicine program the “Mobile Health Team” and recently completed a pilot program in which community paramedicine was used for patients with congestive heart failure (CHF). In this model, the team is activated when a patient with CHF is discharged from the ED. Community paramedics visit the patient at home, perform a detailed assessment, reassess the patient’s weight and condition, and, with remote physician direction, administer intravenous diuretics and other patient-centered care. Over a 1-year period, this pilot program prevented 42 potential admissions and 168 inpatient days among 704 patients, reduced ED visits for CHF by 50%, and reduced overall readmissions by 15%.
It's no accident that Geisinger's Mobile Health Team is focusing, in part, on supporting congestive heart failure patients in their homes. There are penalties incurred by hospitals for the readmission of patients recently discharged from the hospital and this is a common scenario for those with CHF (see: Telemedicine Used in New Healthcare Settings Like Coaching; Home Monitoring of Discharged Patients by Hospitals for Cost Savings). Organizing mobile health teams makes perfect sense because the idea takes advantage of well-trained teams of healthcare professionals who are already operating in the field, primarily to transfer patients from their homes to the hospital and for emergency calls. The mission of these "paramedicine teams" is then broadened to assess patients and administer drugs intravenously to them in their homes under physician direction and thus reduce readmission rates as detailed in the excerpt above.