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Rugby Community Paramedic Program

Summary 
  • Need: Low patient volumes, a shortage of EMS volunteers, and an aging population in a 5-county North Dakota region required a change in the way the Rugby EMS team delivered care.
  • Intervention: Through the Rugby Community Paramedic Program, EMS staff brought medical care to patients transitioning back into their homes, including hospice patients and those with chronic conditions.
  • Results: The program's early intervention methods helped reduce the number of emergency room admissions and the escalation of medical conditions. Patient satisfaction improved, and the program gained the trust of patients and medical staff in Rugby and surrounding areas.

Description

The Rugby Community Paramedic Program was based out of Rugby's Emergency Medical Service (EMS) at the Heart of America Medical Center, a Critical Access Hospital. It was started as a pilot project of the North Dakota Department of Health Community Paramedic Program in order to fill healthcare delivery gaps in Rugby and its surrounding 5 counties: Pierce, Benson, McHenry, Rolette, and Bottineau. Low patient volume, a shortage of EMS volunteers, and an aging population in this region were some of the reasons Rugby's EMS took on this project.

Heart of America Medical Center Logo

Through the program, the team's 7 full-time paramedics and 3 full-time emergency medical technicians (EMTs) made non-emergent house calls to patients enrolled in the program's transitional care or chronic care programs. Medical services were brought to the patient's home in an effort to reduce hospital readmissions and catch medical problems before they escalated. Since 2016, the Rugby Community Paramedic team also assisted as primary hospice care providers, regularly visiting and offering palliative care to home-bound patients within their service area.

This program was financially supported by the Heart of America Medical Center's Accountable Care Organization and received in-kind donations from the hospital. The program also worked in partnership with the counties' public health units, making and accepting patient referrals. As of 2018, the program is no longer in operation.

Services offered

Paramedics and EMTs provided the following services to patients in their homes consistent with their authorized scope of practice:

Rugby EMS Ambulance Fleet
  • Assessments
  • Wound care
  • Vital sign monitoring
  • Medication administration
  • Blood glucose monitoring
  • Laboratory draws
  • Medication reconciliation and compliance
  • Home safety inspections

Patients enrolled in 1 of 2 Community Paramedic programs administered by the EMS staff:

  • Transitional care:
    • Primary care medical services were administered in a patient's home.
    • Telephone follow-up calls were made after each appointment.
    • The goal was to prevent hospital readmissions.
  • Chronic care:
    • Included evaluations, screenings, and care for patients with chronic diseases. EMS staff also made referrals for adjustments to the patient's home environment to better accommodate their medical situation.
    • Telephone follow-up calls were made after each appointment.

EMS staff, providers, and nurses at the Heart of America Medical Center identified patients to enroll in these 2 programs. The hospital's care coordinators scheduled visits, monitored, and evaluated the care given to each patient. Patients were enrolled until their medical issue was resolved or until they moved into assisted living.

In addition to these services, the Paramedic Program offered transitional and follow-up care for patients who were being transferred to another facility.

Results

Overall, this program saw a reduction in the number of emergency room and hospital admissions. Because of the paramedic's regular presence with these patients, potential medical problems were detected early. For instance, wounds were treated before becoming septic, and chronic respiratory disease patients received early rehabilitation.

Patient satisfaction improved, and the Rugby Community Paramedic Program gained trust of patients and medical staff in Rugby and surrounding service areas.

Barriers

Because the program was a pilot project, there were some initial challenges the Rugby Community Paramedic team encountered:

  • Adjustments involving the Heart of America Medical Center staff and the Rugby EMS team had to be made to accommodate the new model of EMS staff providing clinical services in patients' homes that had traditionally only been offered in a medical facility.
  • Patient care plans created by the paramedics and the care coordinator sometimes clashed with patients' wishes and had to be adjusted appropriately.
  • Hospice regulations stating that patients needed to be within a 60-mile radius of a hospice provider disqualified some of the patients within Rugby's EMS service area from receiving hospice care from the Rugby Community Paramedic Program.
  • Because the Centers for Medicare and Medicaid Services does not offer reimbursements for community paramedic programs in North Dakota, the program needed to find other funding sources. They worked with the Heart of America Medical Center, who designated funds to pay full-time and part-time EMS staff. They also use "off-production time" when EMS staff is not on a call to help in the emergency room and screen incoming 911 calls.

Replication

  • A necessity for any rural EMS program is to be adaptive and open to incorporating multiple patient scenarios into the program's scope.
  • A community paramedic program may not work as effectively without existing as a part of an established structure like a healthcare system or public health unit.
  • Have a champion within your healthcare system. Support from a clinician or administrative advocate can help your program capitalize on resources, navigate the healthcare system, and gain referrals.

Rugby's Community Paramedic Program adapted key principles of California's Community Paramedic Project model. Rugby EMS offers training for new and current EMTs, but because North Dakota doesn't have a formal licensure for community paramedic programs, the EMS staff was trained for the Community Paramedic Program through Hennepin Technical College.

Contact Information

Chase Wrangler, Paramedic
Heart of America Medical Center - Rugby EMS
701.208.1413

Topics
Chronic disease management
Community paramedics
Hospice and palliative care

States served
North Dakota

Date added
November 16, 2017

Date updated or reviewed
December 14, 2018


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.