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Abbeville County's Community Paramedic Program

Summary 
  • Need: To reduce non-emergent visits to the emergency department as well as inpatient stays in rural South Carolina.
  • Intervention: A community paramedic program was started in Abbeville County, providing in-home preventive care to patients.
  • Results: Emergency room visits have decreased by 58.7% and inpatient stays by 60%. Many patients previously needing consistent services now only need occasional check-ups.

Evidence-level

Effective (About evidence-level criteria)

Description

Residents of Abbeville County, South Carolina utilize healthcare services at a higher-than-average rate than the rest of the state. Patients without health insurance often visit emergency departments either for non-emergent issues or as a direct result of their lack of preventive healthcare. A service was needed to help reduce the emergency costs for hospitals and offer medical care for the underserved.

When David Porter joined the Abbeville County EMS as their director, he began researching community paramedicine (CP) programs. Often referred to as "mobile integrated healthcare," this emerging field brings the paramedic to the patient in order to provide non-emergent preventive and follow-up care. Patients served often do not have a form of health insurance or a primary doctor.

David Porter and Dr. Keith Scott, one of the overseeing physicians for the Abbeville CP program
David Porter and Dr. Keith Scott, one of the overseeing physicians for the Abbeville CP program

Porter, along with the Abbeville County Emergency Management Services (ACEMS), the Abbeville Area Medical Center (AAMC), and the South Carolina Office of Rural Health (SCORH), launched a CP program in Abbeville County on October 1, 2013.

The goal of the CP program is to prevent an emergency situation by identifying potential causes for a patient's health problems. Hypertension, asthma, diabetes and congestive heart failure, are all prevalent issues throughout Abbeville County and are monitored through the CP program. Paramedics visit patients at their home within 72 hours of a hospital discharge, and all CP activities are overseen by a local physician.

Get a closer look at how Abbeville County's Community Paramedic Program operates:

Initial funds to support the program came from the Duke Endowment and SCORH. Paramedics who staff the Abbeville CP program, all of whom have received trained through a curriculum created by the Community Healthcare and Emergency Cooperative.

Program partners include:

Services offered

Current services are suspended due to COVID-19; however, the program has operated - and is expected to resume - as follows:

With a physician's order and a patient's consent, the Abbeville CP paramedics follow up with patients outside of the traditional healthcare setting, usually in the patient's home. They provide services such as:

Several of Abbeville's CP paramedics
Abbeville County's community paramedics visit patients outside of the traditional healthcare setting.
  • Primary and discharge care
  • Chronic disease monitoring
  • Medication reconciliation
  • Healthy lifestyle education
  • Nutrition review and education
  • Patient education
  • Home safety assessments
  • Cardiovascular monitoring and education
  • Respiratory management
  • Follow up after discharge

When community paramedics are not conducting home visits, they are utilized in AAMC's emergency room. Using a "Pit Crew CPR" model, they provide medical support to clinicians for patients in emergency situations.

Area healthcare providers regularly refer patients to the CP program. AAMC CP nurses serve as liaisons between physicians, paramedics, and the patients by:

  • Creating care plans
  • Handling medication reconciliation
  • Linking the patient to community resources
  • Providing patient education
  • Consulting with referring physicians
CP Home Visit Chart - Abbeville County's Community Paramedic Program
This chart represents the stages of a CP visit.

Results

Many patients who have needed consistent services have been stabilized and now only need occasional check-ups. Initially, 75 patients were enrolled in the CP program and regularly received visits. The South Carolina Rural Health Research Center conducted an initial evaluation of the program in 2015 and found the following successes:

  • 30 patients were consistent with their exercise plan, 32 with their diet plan, and 67 with their medication plan
  • 773 total CP home visits were made
  • 58.1% decrease in emergency room visits
  • 60% decrease in inpatient stays
  • 41.2% decrease in 30-day readmission rates 
  • 85% of diabetic patients decreased their blood glucose levels
  • 72.7% of hypertension patients showed a decrease in blood pressure rates
  • 22 patients obtained insurance
  • 62 patients were connected to a medical home
infographic sharing community paramedic program results

The Donabedian Model was used to measure the quality of the program by an evaluation team through the South Carolina Rural Health Research Center (SCRHRC).

graphic depicting the Donabedian Model

Abbeville's success has led to a discussion between South Carolina's healthcare leaders to implement this program state-wide. Currently, there are 8 other agencies in South Carolina intending to start CP programs that mirror Abbeville's model.

The program structure and results were reported in the Abbeville Community Paramedicine Evaluation Report authored by the South Carolina Rural Health Research Center.

David Porter explains the Abbeville CP program in this article:
Reducing Readmissions to Reduce Penalties: Where to Begin?

The program's emergency department reduction and patient outcomes were evaluated in this journal article:

Bennett, K.J., Yuen, M.W., & Merrell, M.A. (2017). Community Paramedicine Applied in a Rural Community. Journal of Rural Health. Article Abstract

Challenges

  • Securing long-term funding
  • Sustained partnership from hospitals, primary care practices, hospice, and home health organizations
  • Cultural and organizational differences between partnering organizations
  • Patient recruitment
  • The resignation of a CP paramedic
  • Paramedic preference requests from patients
  • Scheduling complications
  • The length of time required of paramedics to enter patient data into electronic medical records
  • Non-progression in some patients

Replication

The Abbeville CP program suggests that those interested in starting their own program take the following steps before beginning:
  1. Familiarize yourself by reading material regarding community paramedic programs and all they entail
  2. Identify the potential target market of your program
  3. Focus on high emergency room and inpatient utilizers
  4. Reach out to other healthcare providers and EMS agencies who are involved in community paramedic programs
  5. Develop an advisory committee by approaching key stakeholders
  6. Establish leaders who will be champions of your program and communicate your message consistently to the public

Below are some additional recommendations to apply after starting a program:

  • Explore alternative transportation methods for CP patients
  • Ensure that documentation methods improves work flow and care management
  • Dedicate one staff member to be in charge of CP scheduling
  • Hold regular meetings to increase communication between partners
  • Because of the difference in positions, offer additional training to paramedics taking on a CP role and explore methods to improve CP workload issues

Contact Information

Chris Oxendine, MD, Co-Director
Abbeville County's Community Paramedic Program
Abbeville County EMS
864.366.9681
coxendine@abbevilleareamc.com

Topics
Community paramedics
Wellness, health promotion, and disease prevention

States served
South Carolina

Date added
December 3, 2015

Date updated or reviewed
December 9, 2020

Suggested citation: Rural Health Information Hub, 2020. Abbeville County's Community Paramedic Program [online]. Rural Health Information Hub. Available at: https://www.ruralhealthinfo.org/project-examples/866 [Accessed 19 September 2021]


Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.