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Region of the Week: Dorchester County, South Carolina
Study finds strong support for mobile heart-failure care, but reimbursement rules stand in the way
Home-based heart failure care won a lot of trust, but it didn't move the readmission numbers
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Region of the Week: Dorchester County, South Carolina
Dorchester County's Community Paramedic Program just wrapped its first year, and the numbers tell the story of a program that grew faster than anyone planned.
Angelina Johnson, the county's first community paramedic, has logged more than 1,200 patient contacts in a year working alongside traditional EMS calls
The program connected 200 patients to primary care, completed 134 post-overdose visits, and helped 24 people into substance-use treatment
Beyond the medical work, it moved 11 people out of homelessness, distributed 77 pieces of durable medical equipment, and linked 82 patients with Adult Protective Services
Johnson estimates she's freed up an ambulance for another emergency about 80% of the time she's responded to a call herself
The county is adding a second community paramedic this year, with a long-term goal of having one on every EMS shiftRead online
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A Columbia Nursing-led study looked at what happens after a heart failure patient leaves the hospital, when a paramedic shows up at their door instead of them driving to a clinic. Researchers interviewed patients, caregivers, providers, and health system leaders who took part in the Mighty-Heart trial, which tests in-home and telehealth visits from paramedics as an alternative to standard follow-up care.
The people actually using it, patients, caregivers, and clinicians, spoke favorably about it, especially the home monitoring piece and its ability to reach populations that don't always get consistent follow-up care
Despite that goodwill, the study found real friction points: the operational complexity of running a mobile health program, murky reimbursement pathways, regulatory hurdles, and limits on what paramedics are allowed to do under current scope-of-practice rules
The paper, published in JAMA Network Open on August 21, 2026, builds on last year's JAMA Internal Medicine report on the trial's main results, which had already shown the approach was clinically effective
The takeaway is less about whether people want this kind of care and more about whether the system is built to pay for it and sustain it at scale
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This is the more detailed writeup of the same MIGHTy-Heart trial, and it fills in the numbers the other article left out. The trial ran across 11 hospitals in two New York City health systems from 2021 to 2024, and the results are more complicated than "patients loved it."
The core finding is a split screen: 30-day readmissions were nearly identical between mobile integrated health and the standard transitions-of-care coordinator model, 20.3% versus 20.4%, and health status scores didn't differ significantly either
Despite that, patients, caregivers, and clinicians described real satisfaction with the program, especially the reassurance of being monitored at home after discharge
The people enrolled looked different from the broader heart failure population at those hospitals: 50% Black or African American versus 9% systemwide, suggesting the program reached patients who aren't always well served by standard follow-up
One exploratory finding stood out, patients under 70 showed more improvement in health status with the home-based model, though researchers flagged that as preliminary
The barriers are structural rather than clinical: EMS reimbursement has traditionally been tied to transporting a patient to the hospital, so a visit that keeps someone at home doesn't fit the existing payment model, and state rules on what a paramedic can do in a patient's home add another layer of frictionRead online