Grube M, Sundberg G, Olsen D, Kram JJF. Hot spotting medically complex at-risk patients: does it decrease hospital and emergency department admissions? Poster presented at: Aurora Scientific Day; May 22, 2019; Milwaukee, WI.
Poster presented at: Aurora Scientific Day; May 22, 2019; Milwaukee, WI.
Background: Our previous research has shown that hot spotting medically complex at-risk patients may improve patient outcomes and decrease health care costs.
Purpose: The purpose of this project was to extend our previous efforts for the most complex patients at the Family Practice Center clinic in Aurora St. Luke’s Medical Center and add one additional site, the Family Care Center clinic at Aurora Sinai Medical Center.
Methods: During 2018, new at-risk patients were identified and tracked at two family medicine sites. Each patient verbally consented to voluntary participation in the hot spotting intervention. A new interdisciplinary team was created at the second clinic site, which required additional buy-in to the intervention’s concepts. We compared number of hospital admissions, emergency department (ED) visits, and estimated cost savings before and after a 9-month intervention period. Basic descriptive statistics were conducted to describe the overall population. Paired t-tests were used as appropriate. A P-value less than 0.05 was associated with statistical significance.
Results: A total of 35 new “hot spot” patients were identified. This patient cohort had mean age of 56 years and was predominately female (69%). Prevalence of mental illness was 89%. Additionally, 66% had communication problems (17% with primary language other than English), 63% had caregivers suffering from caregiver fatigue, and 49% had safety concerns. Furthermore, 34% of patients were considered underutilizers of health care. Although not statistically significant, mean total ED visits (3.6 vs 2.7; P=0.102) and hospital admissions (1.3 vs 0.8; P=0.087) decreased per person. Charlson scores did not change following the intervention. Cost reduction based on these decreased rates was determined at $87,000 ($2485/ patient), equating to a 2.09 return on investment. Even without knowing the financial aspects, clinic staff were very satisfied with the intervention. Overall, 97% of provider respondents felt hot spotting patients was a good idea after the intervention, compared to 78% before, and 76% felt the intervention helped them take better care of their patients.
Conclusion: Extending our hot spotting intervention to an additional clinic site showed similar decreases in hospital and ED utilization as previously reported. Moreover, there continued to be cost savings at both sites. Therefore, our pilot efforts will be extended to a third nonresidency clinic site in 2019 for further evaluation.