McKINNEY (Dec. 15, 2014) — McKinney Fire Dept. (MFD), in June 2013, began an innovative approach to care for frequent users of the 9-1-1 system with the implementation of the Community Healthcare Paramedicine (CHP) program. Since implementation, the initiative has been recognized as a program model nationally and internationally. Recently, representatives of the McKinney CHP led a session on benefits, successes and lessons learned at the national conference for the Institute for Healthcare Improvement in Orlando, Fla.
CHP Associate Medical Director, Dr. Elizabeth Fagan of Baylor Health Care McKinney, along with MFD Emergency Medical Services Chief Jason Hockett and Advanced Practice Paramedics Daniel Frey, Brian Roether and Christopher Waller provided an overview of the vision, design, implementation and success of the McKinney program, followed by a group discussion to answer questions from physicians, nurses, emergency responders and health officials from around the world.
According to the McKinney team, a key component of CHP is determining if the caller has an underlying, unmet need. As an example, one McKinney patient had lived for a number of years in a group home but had been determined capable of living independently. Unfortunately, the patient was unaware of social services and had no guidance in seeking assistance. Often with no food, the individual called 9-1-1 and was transported to the hospital, because there was a certainty of being provided a meal. By identifying the underlying cause of the frequent 9-1-1 calls – in this case hunger - and connecting the caller with appropriate social services, the individual’s use of 9-1-1 reduced significantly.
Another patient was embarrassed by the inability to read prescription labels, often guessing which medication treated a particular symptom and what time of day or number of times a day to take the medication. Subsequently, the individual often missed doses or took too much or too little of a medication, leading to a myriad of other issues. Once the reading difficulty was identified, CHP paramedics coded prescription bottles by drawing stars on night time medication bottles and the sun on morning medication bottles. In addition, they drew depictions of what illness or ailment the medications treated, i.e., eyes, heart, lungs.
Coordination between the medical community and all caregivers is imperative. Many CHP participants are being treated for five or more chronic illnesses. Most patients see multiple physicians. Paramedics commonly encounter patients with the same medication prescribed by different physicians under different names (generic vs. brand name), different prescribed dosages of the same medication, expired medications and a variety of over the counter medications. By facilitating communication between all providers, the CHP helps to alleviate confusion, prevent duplication, overmedication, and adverse interactions of medications. With weekly review and reconciliation of medications, paramedics track patient compliance and identify potential problems before an emergency occurs.
As changes to the U.S. healthcare system continue, reimbursement to medical care providers will be significantly impacted by frequent readmissions for the same illnesses, creating an additional financial burden on service providers. One of the greatest successes of the McKinney CHP is the reduction of readmissions in the initial study group by more than 60 percent.
Advanced paramedic education is a vital component of the program. Once accepted for the CHP, the paramedics undergo eight weeks of intense training, including an internship in the hospital setting with an emergency medical physician. According to Dr. Fagan, “These paramedics are trained at the level of a medical student. They are highly skilled professionals and strong patient advocates.”
Believed to contribute to the success of the program is the fact that firefighters are generally viewed as trustworthy by the public. National studies indicate that a firefighter is the most highly trusted profession in our country. Because of this trust, participants are often comfortable disclosing information that they may otherwise withhold from their medical team, family members or other caregivers.
“Our CHP medics visit these individuals in their homes one or more times per week,” commented EMS Chief Hockett. “They become like a member of the family.” They are treating the medical condition of the participant, and they are filling other needs. “If someone has a beeping smoke alarm and they can’t replace the battery, the CHP team will take care of it on the spot. If a patient can’t go to the doctor for follow-up appointments due to lack of transportation, they will identify a resource. If the furniture layout in the home prevents use of a walker or wheelchair, they will move furniture to improve mobility and remove potential fall hazards.”
Education of patients is imperative. During regularly scheduled visits, key healthcare issues are addressed and appropriate illness, medication and treatment messages are reinforced to ensure full understanding by the patient, family members and caregivers. Patients must sign a contract to follow recommendations of the CHP, as well as their physicians and other health professionals. Progress is tracked on a weekly basis, with the goal of the patient becoming self-sufficient in meeting their healthcare needs, leading to eventual release from the CHP. If patients don’t comply, there are provisions to remove them from the program as a last resort.
Since implementation of the CHP in McKinney, emergency medical professionals from eight states have inquired about program design and implementation. Information has been provided to 67 fire and EMS departments across the country. EMS personnel from three states have visited McKinney to ride along with CHP paramedics and observe interactions with patients, families and medical providers. In addition, multiple fire and EMS agencies from across Texas have participated in ride-outs and observations.
“The need for this type of outreach has long been recognized in emergency medical services,” observed McKinney Fire Chief Danny Kistner. “McKinney is excited to take a leadership role in the industry and influencing the direction of emergency medical care in a manner that is beneficial to the patient and the healthcare community.”
About the McKinney Fire Department
The McKinney Fire Department is dedicated to providing the community with the highest standards of service through prevention, training, education, suppression and emergency medical and emergency management services. We will provide this service with loyalty, integrity, accountability and teamwork. The Fire Department is located at 2200 Taylor-Burk Dr. in McKinney. Non-emergency number is 972-547-2850. For more information, visit mckinneyfire.org.
McKinney, Texas, is unique by nature. The city is No. 1 on America’s Best Places to Live list published by Money Magazine. As one of the fastest-growing cities in the United States, McKinney has a current population of more than 149,000. Established in 1848, the city is located 30 miles north of Dallas and is the county seat of Collin County. McKinney offers rolling hills, lush trees, a historic downtown square and unique neighborhoods and developments. Visit the city’s website at mckinneytexas.org.