Community Health Access Program (CHAP)

Background
Christian Hospital EMS  Advanced Practice ParamedicIn the fall of 2013, a team of employees was convened to improve the health and wellness of citizens served by Christian Hospital. An analysis of data found that 48 percent of all Emergency Department visits and 40 percent of all EMS visits were deemed non-emergent. 

In partnership with the Patient Protection and Affordable Care Act (ACA), Christian Hospital leaders were committed to improving the individual patient experience of care, improving the health of populations and reducing the per-capita costs of care.

Objective
• Address community needs
• Improve effectiveness of delivery of care
• Ensure that appropriate resources are available for the patients we serve
• Assist with improving access to medical coverage and services

Program Overview
Unlike any other organization, Christian Hospital is coordinating efforts of both EMS and the Emergency Department to re-navigate non-emergent patients to receive care in a more appropriate setting. Christian Hospital has also committed to developing a partnership with other organizations and resources in the community to improve the lives of our patients. 

The CHAP program has three components: 
  1. Advanced Practice Paramedics and ED Triage Nurse
    • Expanded Roles and Responsibilities
    • Conduct Medical Screening Exam
    • Patient is referred to Health Resource Center, a PCP, or Community Resources
  2. Community Health Resource Center
    • Locations at both Christian Hospital and Northwest HealthCare
    • Open daily by referral
    • Patients referred by the ED and Advanced Practice Paramedic
  3. Partner with Community Leaders and Organizations
    • Establish relationships with existing community resources
    • Provide guidance to patients on available resources

The over-utilization of Emergency Medical Services (EMS) and the Emergency Department (ED) is a common challenge across the medical field. Members of our community often call 911 or utilize the ED as their resource for primary care rather than seeking medical attention from their primary care physicians (PCP) or utilizing other community resources. 

Another common challenge is a patient’s being released from the hospital and readmitted within 30 days. Most of these patients do not follow up with their PCP within 72 hours as advised, and some are prone to complications or do not understand their discharge instructions. 

Lastly, hospice patients periodically have their hospice status revoked due to family requesting treatment and transport for their loved ones when they are nearing their end of life. 

Christian Hospital is dedicated to develop a process that ensures our community is navigated to the most appropriate resource. Our program is called the Community Health Access Program (CHAP) and will target community health care needs. 

At the forefront of CHAP are specially trained paramedics. The Advanced Practice Paramedics (APPs) work closely with the department medical director and other physicians to ensure the right patient resource is given at the right time. CHAP is structured and led by our Community Health Access Program supervisor under the guidance of the chief of Emergency Medical Services. 

CHAP focuses on a number of community healthcare needs. Following is an overview of the objectives and program goals:

Navigating the Health Care System
Over the years, patients have used EMS and ED as a safety net for primary care. In the days of the Affordable Care Act (ACA), we are now charged with developing a healthier community and getting patients the resources needed to live healthier lifestyles. This component assists patients to necessary resources, which might not be an ambulance ride or ER visit. Calls that are dispatched with a lower priority will get an ambulance response as well as an APP response. The APP will conduct a full patient assessment and determine if a life threat or potential life threat exists. If there is an emergency, the patient will be transported to the hospital by ambulance. If the APP determines no emergency conditions exist, the patient will be navigated three ways:

  1. The patient will be treated at home
  2. The patient will be given a referral to our Community Health Resource Center
  3. The APP will schedule an appointment with a primary care physician 

    Our goal is to ensure all patients that do not have a PCP are linked up with one. 

Hospital Readmissions
Hospitals are in the process of reducing the readmission rate of four patient conditions:

  1. Congestive Heart Failure (CHF)
  2. Myocardial Infarction (MI)
  3. Chronic Obstructive Pulmonary Disease (COPD) 
  4. Pneumonia

If a patient is released from the hospital and readmitted within the next 30 days, the hospital will not receive any additional reimbursement; rather, it will receive a penalty. To avoid this, the APPs will make house calls on these potential, high-risk readmissions. We will ensure they are progressing well and taking their prescribed medication, and we will get them on a healthier path at home. This will decrease the likelihood of their seeking medical treatment in the ED and promote regular visits with their PCP.

Programs in other parts of the country are documenting no re-admissions in a 90-day period. This program is saving hundreds of thousands of dollars in other EMS systems. 

Hospice Revocation
Hospice is important for end-of-life comfort. As patients near the end of their lives, family members might feel helpless and, at times, panic. Often, the family will reach out to 911 for assistance. Once EMS is on-scene, we transport patients to the Emergency Room and they are possibly admitted. However, once the patient enters the ambulance, charges are incurred that revoke the patient’s hospice status, making the hospice organization responsible for payment. 

Working with the hospice, we can flag hospice patients addressed into our Computer Aided Dispatch (CAD) and -- when a call comes in -- we can dispatch an APP to treat the patient in the home, assist the family with coping skills, and wait for the hospice nurse to arrive. 

Over-utilization of our EMS and ED by the community is occurring frequently. Our program will focus on members of the community that activate the 911 system fifteen or more times in a six-month period. We will reach out to these citizens and offer assistance with their health care needs by enrolling them into our Community Health Access Program. This will include up to eight weeks of periodic visitations from an APP to ensure the enrollee has the needed resources to manage their care and daily needs. Upon program completion, we hope to provide enough education and resources to ensure the patients are able to enhance their quality of life.

Our program is very unique and structured around the needs of our community. The medical field is calling for use of mid-level providers as a strategy to extend the reach of the physician. This is cost-effective and it makes sense to tap into EMS personnel that already live and work in these communities, in order to augment services and extend health care access.

For questions or to learn more about the CHAP program, contact Shannon Watson at 314.653.5271.


Request a Site Visit

If you represent an EMS department, you plan to be in the St. Louis area and would like to learn more about the CHAPS program, Christian Hospital EMS staff can meet with you. Please complete the form below, including payment. Someone from the EMS staff will contact you. The fee is $1000.

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