Mobile Care Bridges the Gap

In a community with a severe lack of access to care, MLKCH’s Home Paramedicine Program brings the doctor to the patient

It has been four days since Josue Lopez Mendoza, 34, was discharged from MLK Community Hospital where he was treated for a serious abscess in his rectal area. Still in discomfort, he is pleased to greet nurse Michelle Robinson, when she visits him at the small, gated home in South LA where he lives with several family members.

This is the second time Robinson has stopped at this narrow street half a block from the roar of Interstate 110. She has been sent by the MLKCH Home Paramedicine Program, a mobile service that brings healthcare into homes across a vulnerable South LA community that often struggles to access care. 

Indeed, home paramedicine, referred to as “house calls” in another era, is a response by MLKCH to the needs of patients as they recover from hospitalization—and an antidote to the severe doctor shortage in South LA’s low-income, majority-minority community.  At last measure, the hospital’s service area lacked 1,500 doctors relative to communities of similar size in California.  

Extending a lifeline of care

Just as it was at Robinson’s first visit, Lopez Mendoza is unable to sit for his vitals to be taken because of the pain he knows it will cause him. Instead, the recent immigrant from Guatemala remains prone on a single bed as Robinson’s assistant Christine Rideaux bends to take his vitals.

“He has no diabetes, no history of hypertension. Everything was normal… and then this abscess happened,” Robinson says. ”It’s concerning.”

When the team redresses his wound, Mendoza’s mother is called into the room to observe the procedure and compare it with what she has already been doing for her son. Relieved to find the wound clean and clear of infection, Robinson compliments the caregiver on her efforts. 

“It’s not always like this,” Robinson says as she packs up her equipment. “Sometimes the family caregivers are so overwhelmed with instructions at discharge that they can’t remember the process. That’s where we step in.”

“I appreciate the service,” Mendoza says in Spanish. “I don’t have a car and I can’t sit in a vehicle. There’s no way for me to recover without this team.”

Filling an abyss of care

MLK Community Hospital’s Emergency Department is one of the busiest in the nation; this year approximately 120,000 patients will pass through a facility built to treat 30,000. The high volume has everything to do with Medi-Cal’s poor reimbursement rate, making it unaffordable for physicians to work in the area. In response, MLKCH’s ED has become the de facto destination to access even basic primary care.

The MLKCH Home Paramedicine Program, conducted in partnership with the mobile ambulance service DocGo, aims to reduce pressure on MLKCH’s ED by ensuring that patients do not return to the hospital after discharge.  

 “When our patients go home, they often confront the area’s major healthcare shortage,” says Dr. Jorge Reyno, Senior Vice-President of Population Health at MLKCH. “We give priority to patients who have conditions where they might not have the correct follow-up care.”

Reyno says that home visits are of great benefit to patients because they often prevent further complications. “We know from studies that patients with complex conditions are most likely to return to the hospital within the first seven days after discharge, so we try to visit as soon as possible,” he says. 

“The first days home can be scary for anyone,” Reyno continues, adding that the visits help to enable the patients to be plugged into virtually any resource they need through the hospital’s care management team. 

“The visits also allow the nurses to check on the patient’s environment,” Reyno says. “Is it conducive for patient recovery?  Are there issues that we need to address? Something like not having a refrigerator can be a big problem.”

Going the distance to help

When the paramedicine team arrives at the next stop for the day, at a duplex in South Gate, the patient is not home. Robinson converses in Spanish with his wife, who invites the clinicians to wait on folding chairs on the porch.

“This does happen,” Robinson says as she sits down. “In this case, the patient was in the hospital for 14 days and felt he needed some exercise.”

When Jose Gonzalez, 48, returns home, he apologizes for his late arrival. He did not anticipate the time it would take to walk to the market and back.  Jose worked his entire life and would like to work again. But 10 years ago he had a major accident that left him with braces on his leg and screws in his joints.  He is in constant pain and is unable to be on his feet for long.

Robinson discusses the patient’s physician-ordered DASH (Dietary Approaches to Stop Hypertension) Eating Plan that will help keep his blood pressure and diabetes in check. She also confirms that his prescribed vitamins are now ready at the local pharmacy. Gonzalez says that walking there will be his exercise for tomorrow.

Indeed, part of Robinson’s job is making sure medications and supplements are taken correctly. “Sometimes the medication is sitting on the counter, and it hasn’t even been opened,” the LVN says as she and Rideaux head out to their vehicle. “The patient doesn’t understand what it’s for or is afraid to take it. The education we give them can be so important.”

Occupancy and readmission rates down

Another major benefit of the home paramedicine program is that it allows patients to be safely discharged from the hospital earlier.  

“The care team is more comfortable sending the patient home if they know that swift follow-up care is scheduled,” Reyno says. Overall readmission rates to the hospital, and return visits to the emergency department, are also down due to the program. 

“The challenge for us is that the cost of the visits is not generally covered by insurance,” Dr. Reyno says. “In the end, MLKCH pays to ensure the patient gets the appropriate care.”

“We do studies to see if the cost to our operating budget is worth the benefit,” Reyno concludes. “But what really matters is what home paramedicine is doing to heal our patients. Ultimately, this work is about what we can do for our community.”