Background: As of 2017, South Carolina ranked 5th highest in the U.S. for percentage of adults with diabetes, which has negative health and cost implications. The innovative community paramedicine program (CPP) aims to improve management of patients with chronic diseases and high utilization of the Emergency Department (ED), by providing in-home disease management, education, and care/community resource connection by paramedics. The impact of CPs has not been extensively studied in diabetes.
Objective: To assess impact of CPP participation on health outcomes and healthcare utilization for patients with diabetes.
Methods: Retrospective analysis of CPP participants diagnosed pre-enrollment with diabetes. Demographics and variables reported as percentages, and differences between A1c values pre/post CPP tested using Student’s t-test. Healthcare cost and utilization data was extracted from EMR using SAP BusinessObjects and analyzed with Qlik.
Results: From 2015-2019, 64 people with diabetes enrolled. Participants were primarily insured by Medicare (48.4%) and/or Medicaid (35.9%) or uninsured (32.8%). Comparing pre and post-enrollment average values, participants in CPP for >180 days (d) demonstrated a clinically significant improvement in A1c, although this did not reach statistical significance (181-270d: 10.04+/-1.33 to 8.51+/-1.35, p=0.159; 271-365d: 10.83+/-2.95 to 7.65+/-2.39,p=0.098; 365+d: 9.31+/-2.58 to 7.76 +/-1.45, p=0.23). Participants also showed increased rates of screening for microvascular complications. To date, the utilization analysis for the 52 CPP graduates who participated >14d suggests decrease in average cost of care and ED visits per person comparing 6 months prior and up to 6 months post CPP enrollment ($16,514 vs. $4,717; 2.77 vs. 0.73 ED visits).
Conclusions: The CPP demonstrated improvement in disease control and reduced costs/ED visits for patients with diabetes. This is a promising care delivery innovation that merits further research.
M. Eicken: None. D. Lee: None. J.A. Ewing: None. J.N. Butler: None. M.E. Lutz: None. J.Z. Snow: None. C. Hipp: None. D.T. Thomas: None. C.P. Head: None. R.S. Hudson-Dobbs: None. V.E. Green: None. S.L. Weber: None.