Bridging the Gap: CoxHealth’s Advanced Practice Paramedics Program Expands to Rural Areas

An innovative program at CoxHealth is transforming care delivery for patients with congestive heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia. The CoxHealth Advanced Practice Paramedics (CHAPP) program sends community paramedics into the homes of recently discharged patients, providing specialized care outside the hospital. 

The vision: 

The CHAPP program, through Pre-Hospital Services at CoxHealth, was officially launched in 2016 to reduce emergency department visits for specific patients. 

CoxHealth has now expanded the community paramedics program outside of Springfield. First, it included only heart failure patients, but it now includes more chronic conditions and more remote areas near its rural hospitals, including Cox Monett Hospital, Cox Barton County Hospital in Lamar, and Cox Medical Center Branson.   

The vision behind the program is rooted in the understanding that many hospital readmissions for chronic conditions are caused by various gaps, such as transportation issues, misunderstanding of medications, home environments, and other factors. 

“Our goal is to meet patients where they are,” says Chris White, supervisor of the CoxHealth CHAPP program. “Paramedics possess acute skills that enable them to build trust in emergency situations, so this makes them well-suited to guide patients through the vulnerable transition from hospital to home.”  

Patients typically remain in the program for about 30 days, and community paramedics are available 24/7 if needed. 

How it works:  

For inpatients, the process for a community paramedic to visit a patient at home begins at the bedside with a hospitalist (an inpatient physician). A paramedic assigned to the patient throughout the program will meet with them in the hospital to explain the program and will later visit them once they are settled at home.  

The visits focus on:  

- Monitoring vital signs and managing medications for patients.  

- Educating patients and their families about symptom management and early warning signs.  

- Conducting home assessments to eliminate fall risks and address social deterrents.  

- Coordinating follow-up appointments with primary care providers and specialists, which includes assisting the patient in setting up and logging in to telehealth visits.  

For patients who have visited the emergency room more than five times within a specific period, paramedics also serve as mentors. They assist patients in understanding the triggers that lead to their frequent visits and help connect them with community resources for food, housing, and mental health support. 

The impact:  

From Oct. 23 to Oct. 24, advanced practice paramedics enrolled 52 patients in the program in the Monett area, 212 in the Branson area, and 29 in Lamar and surrounding communities.  A total of 964 patients total were enrolled systemwide.  

According to White, last fiscal year, the readmission rates for CoxHealth patients enrolled in the CHAPP program with congestive heart failure, COPD, and pneumonia were all lower than the national average.   

Future goals:  

White emphasizes the long-term goal of the program is to ensure that patients receive the support they need when they need it most. 

"Our patients are our highest priority," says White. "We recognize that accessing care can often be challenging, and we are dedicated to eliminating as many obstacles as we can.”  

For CoxHealth, the CHAPP program is redefining the boundaries of care—one home visit at a time.