2017 Annual Report: Making House Calls in Rural Maine

Bringing Care to Patients in Remote Areas

Community Paramedicine, a unique program of Franklin Memorial Hospital’s NorthStar EMS, reaches out directly to vulnerable people who find it difficult to leave home to get the care they need. In-between emergency calls, which are the priority, specially trained emergency medical technicians (EMTs) and paramedics provide patient care in the home.

They offer free services such as hypertension or weight monitoring, flu vaccines, and medication and diabetes management. The program was piloted four years ago and now covers a 2,800-square-mile service area. “We recognized the need in rural Maine and got involved,” said Mike Senecal, NorthStar EMS director. “We provide assistance to people with chronic illness, or those transitioning from the hospital to home, or just swing by to say ‘hello.’” Working closely with area doctors, EMTs then report any concerns that may affect a patient’s health to the physician for follow-up.

Transforming Care Delivery With Telehealth

Telehealth is transforming the delivery of health care, and the MaineHealth system is leveraging this exciting technology to improve patient care and outcomes. MaineHealth Care at Home’s Telehealth Program uses internet-enabled tablets, video capacity and monitoring devices, together with specialized nursing services, to monitor patients with chronic illness in the comfort of their own homes. From January–June 2017, MaineHealth Care at Home served 571 patients with chronic illnesses; with the benefit of telehealth technology, it achieved an 83 percent patient adherence rate and reduced hospital 30-day readmissions by 1.2 percent. Most important, it enabled patients to remain where they prefer to be — at home.

The MaineHealth Chronic Disease and Telehealth teams, in partnership with Maine Medical Partners Endocrinology & Diabetes Center, have launched Project ECHO (Extension for Community Healthcare Outcomes) at MaineHealth. Project ECHO was started at the University of New Mexico to build relationships between primary care and specialists and increase access to specialty care. The goal is for patients to get the right care, in the right place, at the right time.

Seven MaineHealth member and affiliate sites have joined the ECHO project and participate in a monthly teleconference led by physician champion Dr. Irwin Brodsky and his colleagues at the MMP Endocrinology & Diabetes Center. This teleconference acts like a “virtual grand rounds,” with a didactic component followed by group discussion of cases presented by the primary care physicians.

Connecting New Physicians With Rural Communities

Rural Internal Medicine Maine (RIMM) is a unique internal medicine residency program that trains doctors at both an urban tertiary care center — Maine Medical Center in Portland — and a rural community internal medicine practice — Oxford Hills Internal Medicine (OHIM) in Norway, associated with Stephens Memorial Hospital. Believed to be the first of its kind for internal medicine residencies in the country, the goal of this training model is to better meet healthcare needs by addressing the difficulties in recruiting doctors to rural communities while providing the training necessary to work in this environment.

“We have often found that residents will stay within 50 miles of where they trained. We’re optimistic that with this pilot, more will choose to stay in rural communities,” said RIMM Program Director Thomas Gearan, MD.  Resident physicians complete their three years of training with alternating blocks of time spent at both facilities. Technology is a key connecting element. “One of the reasons why OHIM/Stephens Memorial is a good partner is that we are linked by the same electronic health record, Epic,” said Dr. Gearan. “Videoconferencing also helps connect us for things like medical grand rounds.”

Samuel Ferguson, DO, is the first doctor to begin his training as a first-year resident. A Maine native, he was selected from close to 100 RIMM program applicants and began his rotations in July 2017. Dr. Ferguson earned his undergraduate degree at Elmira College and his Doctor of Osteopathic Medicine at New York Institute of Technology College of Osteopathic Medicine.

Resident physicians manage the care of patients under the supervision of OHIM providers. One of the many benefits of the RIMM program is that residents will develop the skills needed to provide excellent care in a rural setting while working with experienced providers. RIMM will not only increase patient access, but also develop a new, innovative group of internists who will serve our rural communities for years to come.

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