Home Health Program Seeks to Improve Access to Support Services, Information

Posted on by Shivani Majmudar, Northwestern University
A male paramedic performs a health check outside on a man sitting in a chair.
Paramedics bring visual and educational materials and equipment to check patients’ vitals, conduct blood tests, and administer EKGs during Mobile Integrated Healthcare Program home visits. This photo was taken in 2016 before the COVID-19 pandemic. (Photo credit: JOHN STARKS/DAILY HERALD, 2016)

In observance of National Preparedness Month, the Center for Preparedness and Response (CPR) will publish posts in September that highlight ways people and organizations are helping to “create community” where they live.

This student-authored post is published by CPR in partnership with Medill News Service and the Northwestern University Medill School of Journalism, Media, Integrated Marketing Communications. The views and opinions expressed in this article are the author’s own and do not necessarily reflect the views, policies, or positions of CPR or CDC.

Paramedics in Elgin, Ill., stop at the home of an elderly man who was recently discharged from the hospital for uncontrolled diabetes. They first check the man’s vitals, including blood pressure and blood sugar levels, and then review information about his condition and treatment plan with him.

As part of the Mobile Integrated Healthcare (MIH) Program at Advocate Sherman Hospital, a free support program offered primarily to elderly patients with chronic diseases who need additional home health support, these paramedics are helping to narrow the health literacy gap.

Paramedics use weekly one-on-one home visits to help optimize health outcomes among community residents whose low levels of health literacy could put them at increased risk of getting COVID-19. CDC defines health literacy as an individual’s ability to understand basic health information and services to make informed health decisions.

Beyond providing sources of information, MIH paramedics bring a personal touch, serving as an additional support system for patients. This is part of the reason why Sara Larson, a nurse at Elgin Family Physicians, refers patients to the program.

“This program makes patients feel like someone cares about them,” said Larson. “It makes a big difference to see patients’ realities in their homes and adapt their care accordingly.”

Home visits are also opportunities for patients to review their health information and ask questions outside of the hospital, she added.

MIH works with patients who have been hospitalized at least once for chronic obstructive pulmonary disease, diabetes, asthma, pneumonia, or heart failure. It is the only hospital-based paramedicine program in the state.

Tina Link, manager of community outreach at Advocate Sherman and MIH program director, said the program was started to reduce the number of visits to emergency departments for issues that could be managed at home. Issues such as getting prescription refills and not knowing what medication to take.

“There’s a knowledge deficit,” she said. “Some patients don’t know where to go or who to ask. But they know the hospital is open and someone will take care of them.”

Paramedics teach patients how to navigate the health care system so they can understand their conditions and make informed decisions about their care. The goal of the program is to reduce unnecessary hospital admissions and decrease costs.

Last year, MIH successfully lowered hospital readmission rates for their program participants by 58%, according to data provided by Advocate Sherman.

The COVID-19 pandemic has amplified the importance of this program. Both the elderly and patients with certain underlying medical conditions are at increased risk for severe illness from COVID-19, according to CDC.

“Especially with COVID-19, we don’t want people in the hospital who don’t need to be here,” said Jill League, community wellness coordinator at Advocate Sherman, who actively oversees the MIH program. “We want our patients to know how to control their condition so that they can stay home, stay healthy, and have a better quality of life.”

In the five years since the program’s establishment, Link and League agree this year is one of the most impactful. After the onset of the pandemic in March, they said they immediately integrated COVID-19 information into MIH’s curriculum. Paramedics cover COVID-19 signs and symptoms, safety guidelines, and how to self-quarantine.

Program participants have been responsive to this mission. Link said she has noticed patients becoming more conscious of their health and behaviors. They acknowledge that their medical history may put them at increased risk for severe illness from COVID-19 and are eager to work with the paramedics to better understand their health.

“COVID-19 does not just target a certain population,” said Link. “It’s new for everyone and we’re all at risk, so we’re all in this together.” The universality of the pandemic encouraged patients not only to keep themselves healthy but also to protect their neighbors.

MIH has navigated the barriers of limited mobility and uncertainty this summer to offer patients safe, personalized health care in their own homes. Paramedics wear appropriate personal protective equipment and follow proper hygiene protocols between home visits, as recommended by the CDC.

Advocate Sherman’s intervention has not only successfully improved health literacy in Elgin but also has bridged together providers and patients to shape a resilient, well-informed community during these unprecedented times.

Posted on by Shivani Majmudar, Northwestern UniversityTags , , , , , , ,

7 comments on “Home Health Program Seeks to Improve Access to Support Services, Information”

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    As a nurse, we often wonder what happens to our patients after they are released from the hospital. It is not uncommon to see patients return time after time for the same issues. Unfortunately, living in rural areas creates an extra barrier for the elderly when it comes to maintaining their health. I enjoyed this blog because the Mobile Integrated Healthcare (MIH) Program is a great idea. I admire the way paramedics and healthcare professionals go out to the homes of the elderly and educate them on their health. They also give them on the spot checks to ensure their vitals and blood sugar is within normal range. In this time of COVID-19, it is harder than ever for the elderly and this initiative is one step in the right direction to reducing rebound hospitalizations.

    I love the idea of providing weekly visits to those in the community that needs additional education and monitoring to reduce the risk of getting COVID 19 or other complications related to chronic diseases. Many people aren’t health literate, and recruiting health care workers like pandemics was a great idea to “narrow the health literacy gap.” Compassion and having a genuine desire to help others can make a world of difference for the elderly population. Unfortunately, this generation is often overlooked and can feel left out to; so to have workers who care can help the individuals retain information. Also, it’s so important for people to know during this time, the hospital is no longer the safest place to be. As a nurse, I have to continually remind people the best way to be safe and reduce the risk of spreading COVID 19 is by staying home when they aren’t feeling well or having mild symptoms. I agree with the statement, “stay home, stay healthy.” Overall, it nice to see that the efforts made by this program have shown an increased interest in personal health and how individuals can reduce their risk of severe illness. This is encouraging and something that should be considered in other communities.

    This is an amazing way to help people who may have a challenging time deciphering all the medical jargon and instructions given to them once they are discharged from the hospital. This is a great service because it fills the gap that has been widening since the start of the COVID-19 Pandemic. As a nurse who works in a hospital setting, I understand that our discharge teaching may only go so far. We always tell patients to follow up with their provider if they have any questions, but many just will try to figure it out on their own if they are unsure of something. Having medical staff check in with them face to face gives them the chance to ask questions and empower them to stay on track, without having to make a trip to the Emergency room after weeks of noncompliance due to low health literacy.

    As a former home health nurse now working in a hospital, I love the idea of a hospital based follow up care program. In the past three years working in the hospital I have encounter many “frequent flyers”, or patients that are readmitted with the same problems over and over. Most of these patient refuse home care upon discharge and there is no follow up to make sure they fully understand their diagnosis and how to manage it. Helping patients at higher risk of COVID during the pandemic by helping them understand their health and following up on them post-hospital discharge is an excellent way to keep this population of people home and safe. I would love to see more communities initiate a program similar to this one.

    As a current home health nurse, I encounter patients on a regular basis who have just been discharged from the hospital and have no idea what their discharge instruction intel. When coming into the home reviewing their discharge summary often, we discover together that they have missed their follow up appointment. Being given a new diagnosis and new medications or medical equipment is a lot to take in, especially in one session during discharge, it can be very overwhelming. The service that you all are providing for this community is needed and appreciated. I agree that people need to stay away from the hospitals as much as possible. The pandemic has put a strain on health care facilities and if we can provide a service that answers questions or gives reminders to patients, it is a wonderful resource. I chose this blog because I am a home health nurse, and I am aware of the lack of knowledge some patients have related to their health. I enjoy going into the home where they are most comfortable and teaching patients to care for themselves. Also doing bedside nursing I have encountered many things that have occurred due to lack of knowledge such as taking too much medication, or not taking enough.

    As a current home health nurse, I encounter patients on a regular basis who have just been discharged from the hospital and have no idea what their discharge instruction intel. When coming into the home reviewing their discharge summary often, we discover together that they have missed their follow up appointment. Being given a new diagnosis and new medications or medical equipment is a lot to take in, especially in one session during discharge, it can be very overwhelming. The service that you all are providing for this community is needed and appreciated. I agree that people need to stay away from the hospitals as much as possible. The pandemic has put a strain on health care facilities and if we can provide a service that answers questions or gives reminders to patients, it is a wonderful resource. I chose this blog because I am a home health nurse, and I am aware of the lack of knowledge some patients have related to their health. I enjoy going into the home where they are most comfortable and teaching patients to care for themselves. Also doing bedside nursing I have encountered many things that have occurred due to lack of knowledge such as taking too much medication, or not taking enough.

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Page last reviewed: September 28, 2020
Page last updated: September 28, 2020