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Collaborative, home-based care

Elderly and frail patients benefit from receiving care in the comfort of their homes.

Aging in place is easier for the elderly, their caregivers and their clinicians, and community paramedicine makes it possible. The Northwell Health service offers homebound people an alternative to calling 911 for help, often in non-emergent conditions.

"We started providing community paramedicine in 2013, well ahead of the trend," said Karen Abrashkin, MD, medical director of the health system's Clinical Call Center. She is also an internist in House Calls, Northwell's home-based primary care service that provides emergency care to enrolled patients. House Calls also dispatches community paramedics, who determine whether it's best to provide treatment at home or transportation for emergency services.

"Support from many areas of the health system is crucial to helping these patients," Dr. Abrashkin said.

Most House Calls participants have discussed their treatment goals with their physicians, and about 90 percent have established a medical order about life-sustaining treatment.

"We've broken down the silos that separate the nurses, paramedics and internists who function as primary care providers for patients in this program," Dr. Abrashkin said. "All parties collaborate seamlessly to honor a patient's goals of care, keep them where they want to be, and give them timely and appropriate medical treatment."

House Calls follows up with patients to assess symptoms after a community paramedicine response.

Taking a time to teach

Per New York State law, community paramedicine covers only acute-care visits. Community paramedics interact with patients in their homes for an average of 70 minutes.

"Our paramedics provide education on everything from heart failure and diabetes to what may be causing breathing issues," Dr. Abrashkin said. "We also get calls for evaluation after a fall. On those visits, education covers ways to remedy common fall hazards by discarding throw rugs, using assistive devices or putting up rails in bathrooms."

Compassion and efficiency

Physicians work with community paramedics to ascertain when inpatient treatment is necessary, and most patients - 78 percent - get care at home. Compared to people who arrive at the emergency department via traditional emergency medical services, the admission rate is significantly higher for those transported by community paramedics.

"Our patients have an average age of 86," Dr. Abrashkin said. "Many need assistance with activities of daily living - things like bathing or dressing. We find that when these individuals go to the hospital, they become weak and lose remaining functional abilities and often don't regain them after they return home."

In addition to helping patients remain in their homes, community paramedicine programs benefit providers, who score high on satisfaction surveys.

"Paramedics often have relatively short careers because of the nature of the job," Dr. Abrashkin said. "We see high satisfaction with community paramedics because it's essentially another career opportunity. Their expertise creates the care that leads to our high patient and physician satisfaction."

"We see such high potential, we next want to scale community paramedicine to include additional practices and to reach other populations."
— Karen Abrashkin, MD