New reports from the University of California, San Francisco address ongoing community paramedicine pilot programs across the state. In November 2014, the California Office of Statewide Health Planning and Development approved an application from the California Emergency Medical Services Authority to establish a Health Workforce Pilot Project that has encompassed 17 projects in 13 communities across California to test seven different community paramedicine concepts.
The latest reports evaluating California’s Community Paramedicine Pilot Program reaffirm that the projects have improved coordination among providers of medical, behavioral health and social services and reduced preventable ambulance transports, emergency department visits and hospital readmissions. As shared in earlier reports, the pilot projects have not resulted in any adverse patient outcomes. The types of community paramedicine projects being tested are post-discharge, short-term follow up; frequent emergency medical services users; directly observed therapy for tuberculosis; hospice; alternate destination – mental health; alternate destination – urgent care; and alternate destination – sobering center.
The Office of Statewide Health Planning and Development has released quality ratings for the 126 California-licensed hospitals that performed isolated heart bypass graft surgeries in 2015. Coronary artery disease is the leading cause of adult non-maternal admissions to California hospitals, representing nearly 9 percent of admissions. The surgery is the most common surgical procedure for treating coronary artery disease and is one of the most expensive cardiac surgeries performed in California. Hospital performance ratings are based on operative mortality, post-operative stroke and unplanned hospital readmission within 30 days; all measures are risk-adjusted. Because the surgery relies on using a vein or artery from another part of the body to create a new path for blood to flow to the heart, bypassing the blocked artery, hospitals are also rated on their utilization rates for the internal mammary artery.
The Office of Statewide Health Planning and Development (OSHPD) has released its report on the quality of ischemic stroke care at California acute care hospitals between 2014 and 2015, providing performance ratings for 267 hospitals on two risk-adjusted outcome measures: 30-day mortality and 30-day hospital readmission. In cases of ischemic stroke, timely interventions are critical to reverse the damage; reduce mortality, morbidity and disability; and improve quality of life.
30-day Ischemic Stroke Mortality Findings
Statewide, the percentage of patients who died within 30 days of hospital discharge was 9.8 percent, down slightly from 10 percent in the 2013-14 report. The average risk-adjusted mortality rate for the 14 hospitals rated “Worse” (18.8 percent) than the state average was more than three times higher than the average rate for the 11 hospitals rated “Better” (5.5 percent). Seven hospitals rated “Better” in the 2013-14 report were again rated “Better” in 2014-15. Eight hospitals rated “Worse” in the 2013-14 report were again rated “Worse” in 2014-15.