By Sarah L. Sonies
Patients who frequent emergency rooms, earning miles as hospital “frequent fliers,” have left care teams looking to better understand the social determinants that cause their frequent hospital admissions.
A five-student team from Virginia Commonwealth University (VCU) is one of ten across the nation chosen for a six-month learning collaborative to explore the root causes of repeat visits to the hospital and high health care costs. As part of the learning collaborative, these students will identify super-utilizers, known as “hot spotting,” and work with them to decrease utilization and costs.
The team is led by Eveline Chu and Tricia Olaes, medical students in the school’s International/Inner City/Rural Preceptorship program, who will use the experience and their collected data as a medical school graduation capstone project. Other participants include Emily Pratt, a graduate student in the School of Social Work; Andrea Ramos, a student in the School of Nursing; and Aziza Dang, a student in the School of Pharmacy. The interprofessional team includes members who are trained to identify social and societal barriers to health care for patients, as well as members who provide that care.
“What attracted me to the project is that there is this qualitative component to it. We are able to be a part of the community, doing home visits with the patients and helping them navigate the health system,” said Olaes. “As medical students, we typically see patients here in the wards. With this project, we are able to meet the patients where they are and help them with issues in their daily lives.”
The team is student-driven, but several faculty members experienced in family medicine and underserved patients act as advisers, including Katherine Neuhausen, MD, and Mark Ryan, MD. Ryan, medical director of the Preceptorship, says he was drawn to the idea of hot spotting as a way to forward patient-centered care after learning about it in 2011. Ryan read Atul Gawande, MD’s, profile of Dr. Jeffrey Brenner, a family physician at the Camden Coalition for Health and 2013 MacArthur Fellow who developed the hot spotting care model, in The New Yorker.
“In our health care system, we talk a lot about patient-centered care, but we don’t do a terribly good job at it. Even though we are making moves in the right direction, we are still not there,” said Ryan. “I love how the hot spotting model looks at patient-centered care from a very different direction, finding these particularly fixable problems that hadn’t been looked at. Once you step back and find them, there were things you can do; but no one was even thinking of how to look at it from the front end.”
The VCU hot spotting team currently has two patients enrolled in the initiative, and hopes to enroll three more. Following a needs assessment in the patients’ homes, the students will accompany patients on doctors’ visits, even assisting with transportation or helping to obtain health insurance as needed. If a patient is hospitalized, a team member will visit them in the hospital to determine if the action plan should be modified.
“Hot spotting goes beyond the number of people who are admitted to hospitals and looks at how, from the perspective of the individuals, to improve the care system as a whole,” said Pratt. “These initiatives present an opportunity to work with students from different disciplines and expertise in order to give people more well-rounded care.”
Ryan says the team’s work on the hot spotting model could provide a viable and sustainable solution to dealing with high utilizers.
“This model focuses on what patients really need to be well. And it’s not solely more of their health steroid, and it’s not solely more health insurance coverage; it’s that their house is covered and insulated,” said Ryan.
Participating students benefit by developing a greater understanding of all elements of patient and family care, from education to administration.
“It’s been a real exercise in learning how to problem-solve. By bouncing ideas off of one another, we were able to get a system and process together that works really well,” said Olaes. “It’s really opened my eyes to the possibilities of working together as a team.”
The learning collaborative, sponsored by the Camden Coalition for Health, Primary Care Progress, and the Association of American Medical Colleges, will track patient progress and student learning through monthly case conferences and topical webinars with Dr. Brenner and faculty sponsors over a six-month period. Each student team has been awarded a $700 grant to support patient needs such as bus passes, phone cards, and canes. The students will also attend a hot spotter conference to share their work this winter, hosted by the Camden Coalition.