Alexander Delov (not his real name) is an energetic ten year old who suffers from chronic asthma. He has a prescription for an inhaler to control his symptoms, which is effective most of the time. But Alex’s parents both have full times jobs and on several occasions haven’t been able to fulfill his prescription and Alex has ended up in the hospital emergency department. These visits to the emergency department for a chronic condition like asthma should be preventable, according to Tran Miers, VG Clinical Program Director. “This is the goal of our new ‘hot-spotting’ project.”
Hot spotting is the term being used to identify patients who use the emergency department (ED) frequently. Hospital care is expensive and known to be one of the greatest drivers of health care cost inflation in the United States. Too often, people who don’t have an established primary care provider use the hospital emergency department for non-emergency care. With a grant from Providence Health Systems, Virginia Garcia Memorial Health Center is developing a program to both identify frequent ED users and direct them to the care and support they need to stay out of the hospital.
"Based on our data, about 25% of emergency department users who are assigned to VGMHC are not established with a primary care provider,” according to Miers. “And about 6% of those patients went to the emergency department three or more times a year. The focus of the Hot Spotting Team is to provide intensive intervention for these patients with the goal of returning them to a VG primary care team for their ongoing, proactive care.” Many patients who use the ED frequently have chronic conditions, and like Alex, circumstances that keep them from seeking ongoing, preventative health care. There is also a correlation between high ED use and mental or behavioral health issues. This is why the VG Hot Spotting project will be comprised of a multi-disciplinary team. “We are in the process of recruiting for the team which will include a primary care provider, a medical social worker and a community health worker, said Miers. “The team will be based at VG Beaverton, but the care may be delivered in the community to meet patients’ needs.”
Identifying high health care costs associated with individual patients and certain populations is groundbreaking. This ‘hot spotting’ could become a cornerstone of healthcare reform. In 1997, Dr. Jeffery Brenner of Camden, New Jersey developed an innovative approach to delivering care to high heath care cost populations. Hot spotting, originally used by police departments to identify hot spots of crime, is being used to identify the hot spots in health care, where more resources could be beneficial. This model of care depends on a team to support the patients; using frequent phone calls, home visits and connecting patients to the resources they need to support their health. “We are using a similar team-based model to support our high ED users,” said Miers. “Our plan is to serve about 130 patients initially and we hope to reduce non-emergent ED utilization by twenty percent. We’re developing the criteria for patients to be referred to the Hot Spotting team as well as for graduating and returning them to a VG primary care home.”
In VG’s medical home, where patients are cared for by a team of providers, the transition from intensive intervention to ongoing support will be seamless. One of the critical ingredients for success, according to Brenner is building relationships in order to change behavior. “When patients know and trust you, they are more likely to make the lifestyle changes they need to improve their overall health, “said Miers. “At VGMHC, building relationships has always been key in how we treat our patients. “