POP – Community Paramedicine

PACT Program overview

The Paramedic Advanced Care Team Program or PACT is a group of highly experienced paramedics with special training in the acute and sub acute care of the chronically ill. This program emphasizes an all-inclusive approach to the assessment, treatment, and navigation of patients. PACT team members are trained to work closely with the patient’s physician, home health agency, public health, DHS, the local hospitals, and behavioral health. The goal of the program is to improve patient outcome and satisfaction by visiting patients in their home to assesse their condition in hopes of identifying aberrances before they become a threat to the patient’s health and wellbeing.

The PACT program will focus on four areas:

  1. Public Health and Education Program (PEP). This program will work closely with our public health partners. The goal is to identify patients in need of health care and connect them with resources for insurance and care.
  2. Physician Oversight Program (POP). This program works under the direction and oversight of the patient’s physician to improve patient satisfaction and outcome.
  3. Mental Health Assessment Program (MAP). This program will allow our PACT team members to work closely with law enforcement agencies and local mental health providers to navigate patients to the appropriate destination for care.
  4. Home Healthcare Assistance Program (HAP). With this program, we work with our local home health care agencies to improve the value of home health care provided and the satisfaction of the clients that care is being provided for. This is done by bridging the current gaps in health care.

Physician Oversight Program

The Physician oversight Program or POP is one of the four areas addressed by the PACT program. The goal is to provide physicians with a team that can go into the patient’s home under the oversight of the physician and provide assessments, treatment, and evaluation of patient’s environment.

This adds value to the physicians care, by increasing the physician’s understanding of the patients overall circumstances and ability to comply with treatment plans. This is helpful with patients that have a chronic history of non-compliance with treatment plans, or other factors that lead to poor patient outcomes. Because the PACT team goes into the patient’s home, they may be able to identify factors leading to poor patient responsiveness to treatment. Like risks for fall, poor medication compliance, medication errors, or inability to understand written discharge instructions.

This can lead to better patient outcomes, increased patient satisfaction and decreased cost of care. The program also seeks to reduce the number of patients that readmit in less than 30 days for the same diagnosis.

Program Limitations

The PACT program is designed to be a short-term sub acute approach to help the patient understand their disease processes or an exacerbation there of. The goal is to help the patient identify gaps in their care and develop strategies to address those gaps. The program is not intended to provide long-term care or chronic intervention. Most patients should be able to graduate from the program within 30 days of admittance. This program is not intended to be the sole source of care for homebound patients. Homebound services, are best provided by a home healthcare agency. The PACT can provide supplemental services to the home healthcare agency. Such requests must be made through the home healthcare provider agency.

First Interaction

When a physician sends an order for service, a PACT member will set up an appointment to meet with the patient within 24 hours of request. The first visit will consist of a PACT-Paramedic, conducting a home risk assessment, looking for hazards and fall risks.
The PACT-Paramedic will then review the patient’s discharge instructions with the patient and any available care givers. The PACT-Paramedic will insure they understand the signs and symptoms associated with complications of their illness.

The PACT-Paramedic will outline important levels, values, or findings the patient must keep an eye on. A book will be provided, so the patient may document said values. The PACT-Paramedic will work with the patient’s physician and the medical director to provide any care or treatment the patient may need (within the current scope of practice). If the patient needs treatment not provided by the PACT, the PACT-Paramedic will ensure patient is navigated to appropriate care. The PACT program will provide body scales, glucometers, and spirometers as needed for patients that do not have access to them.

Patient and care providers will be given, a 10-digit direct access phone number to the on duty PACT-Paramedic. The patient will be advised to call for any of the following reasons:

  • They have any abnormal changes in their values.
  • They have complications or changes in their medical condition the PACT is treating.
  • They have any questions related to their medical condition the PACT is treating.
  • They do not feel well and they would like a PACT-Paramedic to evaluate them.

If the situation cannot be addressed over the phone and it is related to the condition the PACT is treating, the patient for the PACT-Paramedic will attempt to visit the patient within 3 hours of the request. If the patient’s complaint or complication is not related to the condition being treated by the PACT, the patient will be advised to call their primary care doctor. If the patient’s physician wants the PACT team to assesse the patient, they must submit a request with an order. A full H&P and demographic sheet will not be required.

PACT-Paramedic will conduct a full baseline physical assessment to include vital signs, SPO2, 12 lead EKG, focused physical exam, and any ordered laboratory testing.

At the end of the session patient will be provided with expectations for managing their illness. The PACT-Paramedic will work with the patient to set short term measurable, and obtainable goals. The patient with the help of the PACT-Paramedic will outline feasible strategies to achieve those goals. Strategies will be clear, concise and realistic. The goals and strategies will be written in the patients care management book so the patient has consistent access to them.

Before the PACT-Paramedic leaves, he will check with the patient to see if they have any additional needs or requests. The PACT-Paramedic will also advise the patient or caregiver to call the PACT-Paramedic with any changes. The patient and caregiver will also be reminded to call 911 with any life threatening incidents. After the PACT-Paramedic visits with patient for the first time they will contact the 911 call center and place a note on the address. If 911 is contacted the PACT-Paramedic on duty will be dispatched with the ambulance and fire department.

After every visit, the PACT-Paramedic will complete an ESO report and that information will be provided to the patients care physician.

Ongoing Care Visits

The goal of the program is to empower the patient to manage his or her own care by,

  • Educating the patient and family on the patient’s medical condition and ways to better manage it.
  • Increase medication compliance and reduce medication mistakes.
  • Reduce risk of falls and other injuries.
  • Increase patients accountability for their healthcare and wellbeing while improving their satisfaction with the care provided.

To that end home visits will be provided on a sliding scale as follows,

  • Week 1 – 3 visits
  • Week 2 – 2 visits
  • Week 3 – 1 or 2 visits
  • Week 4 – 1 visit

If objectives have not been met within this time frame or the patient needs additional visits the PACT team may choose to extend this and the patients physician feels additional time in the program may improve patients
Each visit will start with a physical assessment much like the first visit. Then the PACT-Paramedic and patient will have a conversation to discuss the patient’s strategies from the previous visit. The patient will be asked to rate the success of their strategies in meeting those goals, using a scale of 1 – 10. If the previous goals have not been met then the patient must work with the PACT-Paramedic to establish new strategies to obtain those goals. If the previous goals have been met then the Patient and the PACT-Paramedic must work together to establish new ones. In both cases, success will be rewarded and shortcomings will be identified.

If any medical issues are identified they will be addressed as outlined in the flow sheets and protocols. If a patient is to be treated, under the diuretic protocol, then the patient must have a follow-up appointment with his or her physician within 48 hours of treatment. If this is not possible then the patient will be transported to the hospital or heart failure out patient clinic.

Suspension From Program

If a patient is transported to the hospital, they will be placed on suspension from the program. Once patient returns home, they can be readmitted to the program if the patient’s physician wishes.

If a patient continually refuses to comply with their treatment plan, goals, and strategies, they will be suspended from the program. A patient can be re entered to the program within 30 days if they show adherence to the treatment plan and

Failure to readmit to the program within 30 days will be grounds for dismissal from the program.

Program Costs

The PACT program looks to offset a portion of costs with state and private grant funding. This will allow the program to supplement a fair portion of the cost for the first few years. Patients will be asked to pay a fee equal to that of their standard insurance co-pay for every visit. If the patient has no co-pay, they will be required to pay a $35.00 fee for every visit. In both cases patient may be billed for additional costs, for example, laboratory equipment, medical products, and transport miles.

Patients will have an option to participate in the UPRHSD IMPACT membership. This membership will offset the program fee for each visit and reduce the supply costs by half.

We ask that each physician share this program with their patients and encourage them to consider participation. This will reduce the cost of care to patients and improve their ability to meet the challenges of catastrophic illness when it sticks their family.