Paramedics making house calls improve care, reduce costs

The job of paramedic conjures up the image of a someone rushing to an emergency in an ambulance, lights flashing and siren blaring — not Shelly Brown. She's a certified community paramedic with Regions Hospital in St. Paul who drives a Volkswagen Beetle, stops at red lights and leisurely enters clients' homes for check-ins.

She's part of Minnesota's small cadre of certified community paramedics, who visit patients at home to help them with transitions out of the hospital and with managing chronic conditions. The early results indicate the house calls improve patient satisfaction and reduce spending on medical care.

On a recent afternoon Brown dropped by Charlie and Diane Stuns' place in east St. Paul. Charlie Stuns, 64, suffered a stroke in February. He and Diane Stuns initially declined an offer of home visits when the hospital discharged him. But they changed their minds and gave community paramedicine a try.

"I'm really glad that we had Shelly come," said Charlie Stuns, sitting on the sofa in his living room. Diane Stuns said Brown would take Charlie Stuns' vital signs at home and address any concerns they had.

"I don't know what we'd have done without Shelly," Diane Stuns said. "We've come to think of her as the calm in the middle of the storm."

Brown said home visits offer caregivers valuable insight into their patients' lives.

"We're able to go into the home and actually sit down with a patient — versus going to the clinic — and we're able to see what's going on in their lives, what their daily life is like, find out what they're eating, how they're sleeping, what their daily activities look like," Brown said.

She recalled getting to know a woman with diabetes who drank a lot of sugary Mountain Dew and was wasn't taking her insulin properly. Brown said she convinced the woman to drink fewer sodas and taught her how to properly give herself insulin.

The Minnesota Department of Health says community paramedics are working throughout Minnesota, but nearly half of them are in the Twin Cities. State officials say there are currently 127 certified community paramedics and that many more are needed.

Paramedics wishing to get the community certification must have two years of experience and undergo more than 100 classroom hours of coursework plus nearly 200 hours of hands-on clinical training.

Health care is complicated, but one thing is clear: People with chronic conditions such as diabetes account for the vast majority of health care spending — as much as 85 cents out of every dollar.

In addition to helping people make the short-term transition from hospital to home, the long-term goal of community paramedicine is to help people with expensive chronic health problems best take care of themselves.

Regions Hospital has been testing community paramedicine programs for several years. In early 2015, the hospital joined with the St. Paul Fire Department and a community health clinic for a three-year pilot project that made nearly 1,000 home visits to help people manage diabetes and high blood pressure.

Nearly half of the hypertension patients lowered their blood pressure to a healthy range. Almost 80 percent of their diabetic patients reduced their blood sugar levels.

"The cost savings have been tremendous, but really the impact on the patients' lives has probably been even more tremendous," said Dr. Aaron Burnett, an emergency medicine physician at Regions Hospital who oversees the community paramedic program.

"The patients who get a community paramedic intervention not only are coming back to the hospital less, but they're also more satisfied with their care," Burnett said. "They're taking their medication closer to as its intended to be taken, so we're seeing the benefit from the numbers perspective, but we're seeing it from the patient side, too."