Hot Spotting: Innovative Approaches to Caring for the Very Ill

By Melinda Rogers

Could incorporating the philosophy of “hot spotting”—taking the time to better understand what’s going on in the lives of patients who chronically end up in the hospital and frequently access health care—cut overall health care costs while  setting patients on the path to a healthier life?

Jeffrey Brenner, MD, executive director of the Camden Coalition of Healthcare Providers, addressed that question during a session at the 2013 Association of American Medical Colleges annual meeting in Philadelphia.

          Wing of Zock Managing Editor Jennifer Salopek spoke with Dr. Brenner at the AAMC Annual Meeting about the AAMC’s new hot spotting initiative for med students.

Listen here.

Brenner, a family medicine doc, explained how his health care system worked to develop better intervention programs for patients who ended up in the hospital over and over again, sometimes for benign reasons that weren’t flagged by health care providers before a patient was admitted for an expensive hospital stay yet again. Through using “hot spotting” techniques, which sometimes are as simple as talking with patients about their health care practices or taking the time to visit them at home, providers can learn why patients struggle to access primary care.

“Sit down at the foot of the bed, ask patients open-ended questions, and find out what’s going on in these peoples’ lives. Go to their homes. Go with them to primary care appointments, go with them to specialty appointments,” Brenner told attendees.

“These patients are a gift to us. They are like a mirror your can hold up,” said Brenner of high-cost patients. “You can find all the failures of your system by learning about the choices they make (with regards to health care). You will learn more about the future of health care by looking at these patients than you will from consultants.”

Brenner developed hot spotting techniques by working with patients in Camden, one of the poorest and most violent cities in the U.S. He emphasized the importance of getting to know patients better, highlighting cases of patients who may come in five separate times for an STD or unplanned pregnancy. He noted that the top ER diagnosis in Camden from 2002 to 2007 was head colds. Of the total 317,791 ER visits, more than 12,000 were for colds—a condition best suited for primary care providers.

Lack of education isn’t always a factor, however, for “super utilizers.” Brenner noted the case of a patient in a five-hospital system who had 73 CAT scans over a relatively short period of time. That patient, who was well educated, suffered from anxiety, yet health care providers kept searching for a diagnosis. They overlooked the multiple CAT scans despite a fully integrated EHR.

“Sometimes, we doing too much of a good thing,” Brenner said.

Brenner worked in conjunction with the AAMC to develop a guide to put the “hot spotting” model into action in locations across the country. The 10-step guide suggests targeting patients who have accessed care three times or more in six to nine months. Comprehensive resources for health care providers and medical students who would like to participate are available here.

—Melinda Rogers is a communications specialist at the University of Utah Health Sciences Office of Public Affairs. Follow her on Twitter @mrogers_utah.

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