Community Paramedics are Effective at Predicting 30-day Readmission in Heart Failure Patients
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Abstract
Objective: Heart failure (HF) patients are at high risk for 30-day hospital readmission which is a negative predictor of patient-centered outcomes. Community paramedicine (CP) has emerged with a goal of reducing readmissions and currently no model exists to accurately predict those at highest risk. We seek to analyze factors associated with readmission among participants in a CP program.
Methods: Design: A retrospective review of consecutive patients with a HF-related diagnosis who received a home visit by a community paramedic after a hospital admission. Setting: A suburban, academic medical center with an established CP program. Inclusion criteria: All patients with a HF-related diagnosis who received a home visit over the study period. Factors including age, sex, hospital length of stay, time to home visit, discharge destination, participation in other transitional care/home health programs, chronicity of heart failure, care team, and perceived risk of readmission by the community paramedics at the time of home visit were retrospectively reviewed and analyzed. The outcome of interest was 30-day, all-cause readmissions.
Results: From 4/7/2017 to 4/6/2018 there were 592 patients who received home visits. The median age was 70 [IQR 60-79] and 41.9% were female. The overall 30-day readmission rate was 11%. For readmitted patients, the median time to home visit was 6 days [IQR 4-11] versus 10 days [IQR 5-23] for those not readmitted (p=<0.01). Patients deemed to be at risk for readmission by the community paramedics were readmitted more often than those who were not (OR 2.68, 95% CI [1.59-4.52]).
Conclusion: Along with time to home visit, perceived risk of 30-day readmission at the time of a home visit by a community paramedic correlated with rates of readmission. In the HF population, comprehensive models to predict 30-day readmission might be improved by including a subjective assessment by a trained clinician.
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