The highest utilizers of care: Individualized care plans to coordinate care, improve healthcare service utilization, and reduce costs at an academic tertiary care center. Issue 7 (9th April 2015)

• Record Type: Journal Article
• Authors: Mercer, Tim; Bae, Jon; Kipnes, Joanna; Velazquez, Maureen; Thomas, Samantha; Setji, Noppon
• Is Part Of: Journal of hospital medicine. Volume 10:Issue 7(2015)
• Page Start: 419
• Page End: 424
• Publication Date: 2015-04-09
• Subjects: Hospital care -- Periodicals; Clinical medicine -- Periodicals; 610
• DOI: 10.1002/jhm.2351
• Languages: English
• ISSNs: 1553-5592

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jhm2351-sec-0001" sec-type="section"> <title>BACKGROUND</title> <p>High utilizers are medically and psychosocially complex, have high rates of emergency department (ED) visits and hospital admissions, and contribute to rising healthcare costs.</p> </sec> <sec id="jhm2351-sec-0002" sec-type="section"> <title>OBJECTIVE</title> <p>Develop individualized care plans to reduce unnecessary healthcare service utilization and hospital costs for complex, high utilizers of inpatient and ED care.</p> </sec> <sec id="jhm2351-sec-0003" sec-type="section"> <title>DESIGN</title> <p>Quality‐improvement intervention with a retrospective pre/post intervention analysis.</p> </sec> <sec id="jhm2351-sec-0004" sec-type="section"> <title>SETTING</title> <p>Nine hundred twenty‐four–bed tertiary academic medical center.</p> </sec> <sec id="jhm2351-sec-0005" sec-type="section"> <title>PATIENTS</title> <p>Twenty‐four medically and psychosocially complex patients with the highest rates of inpatient admissions and ED visits from August 1, 2012 to August 31, 2013.</p> </sec> <sec id="jhm2351-sec-0006" sec-type="section"> <title>INTERVENTION</title> <p>A multidisciplinary team developed individualized care plans integrated into our electronic medical record (EMR) that summarize patient histories, utilization patterns, and management strategies.</p> </sec> <sec id="jhm2351-sec-0007" sec-type="section"> <title>MEASUREMENTS</title> <p>Primary outcomes included inpatient admissions, ED visits, and corresponding variable direct costs 6 and 12 months after care‐plan implementation. Secondary outcomes include inpatient length of stay (LOS) and 30‐day readmissions.</p> </sec> <sec id="jhm2351-sec-0008" sec-type="section"> <title>RESULTS</title> <p>Hospital admissions decreased by 56% (<italic>P</italic> < 0.001) and 50.5% (<italic>P</italic> = 0.003), 6 and 12 months after care‐plan implementation. Thirty‐day readmissions decreased by 66% (<italic>P</italic> < 0.001) and 51.5% (<italic>P</italic> = 0.002), 6 and 12 months after care‐plan implementation. ED visits, ED costs, and inpatient LOS did not significantly change. Inpatient variable direct costs were reduced by 47.7% (<italic>P</italic> = 0.001) and 35.8% (<italic>P</italic> = 0.052), 6 and 12 months after care‐plan implementation.</p> </sec> <sec id="jhm2351-sec-0009" sec-type="section"> <title>CONCLUSIONS</title> <p>Individualized care plans developed by a multidisciplinary team and integrated with the existing healthcare workforce and EMR reduce hospital admissions, 30‐day readmissions, and hospital costs for complex, high‐utilizing patients. <italic>Journal of Hospital Medicine</italic> 2015;10:419–424. © 2015 Society of Hospital Medicine</p> </sec> </abstract>