Date of latest update
For More Information Contact
Shane Smith, general manager, AMR Arlington (Buford.Smith@AMR.net)
Select patients discharged following treatment for CHF
Patients hospitalized for treatment of CHF have disappointingly frequent readmission rates. Improving pa- tients’ connection to their post-discharge care plan can substantially reduce avoidable readmission arising from medication non-adherence, poor access to prescription drugs and failure to re-connect effectively with their primary care physician.
AMR’s PRIME Medics visit post-discharge CHF patients assigned by Arlington Memorial Hospital to fa- cilitate reintegration into the home, confirm access to medications, review discharge instructions, ensure reconnection with their PCP, monitor weight and blood pressure, and confer with the hospital sponsor about changes in patient condition.
AMR local medical director
AMR and Arlington Memorial Hospital
AMR critical care paramedics
Plans for Sustainability
Long-term plans include linking sustainable program funding to savings accruing to system payers from reduced re-admission rates.
Of the more than 200 patients seen in this program, only 27 were readmitted following their involvement with the PRIME program, compared with 173 readmissions among the same patients prior to care by the PRIME program.