A strategy focused on team-based care and listening to “super-users” helped a Florida health system cut hospitalizations of such patients by a quarter while also driving down uninsured admissions, according to the NEJM Catalyst blog.
University of Florida Health received a $600,000 grant from the Centers for Medicare & Medicaid Services in 2012, write Deepa Borde, M.D., Jacqui Pinkney and Robert Leverence, M.D., of UF Health. Super-users in the UF Health system accounted for 6 percent of the overall population but about a quarter of emergency room visits. The population was divided between ER “frequent flyers” and patients with complicated needs after discharge. The rate of uninsured super-users was more than three times the rate of the general patient population, according to the post.
UF Health set up an “ambulatory intensive care unit,” which performed a needs assessment for each patient, identifying socioeconomic barriers to care such as lack of transportation, low health literacy or substance abuse. In many cases, these factors had to be addressed before more clinical factors such as medication compliance, according to the blog--for example, a female patient was trapped in an abusive relationship, and her uncontrolled diabetes couldn’t be addressed until her home situation was. The team aimed to see ER frequent flyers three to five times to identify the reason behind their use.
Of 635 patients enrolled--186 of which were super-users and the rest of whom were post-discharge--super-user hospitalizations fell 25 percent, while their hospital days were reduced 23 percent and their ED visits within six months of discharge fell 11 percent.
“We found that the most effective way to reduce super-utilizing behavior was to identify what factors in a patient’s life may be contributing to that behavior, and find ways to address them,” the authors wrote. “The Care One Clinic offers a unique opportunity for staff to sit quietly and listen, away from the bustle and distractions of the ED or the inpatient unit.”
- here’s the blog post