Originally published October 6, 2014
By Sonya Collins
This summer marked the launch of the 2014 Hotspotting Mini-Grant Project. The initiative, a collaboration between Camden Coalition of Healthcare Providers (CCHP), the Association of American Medical Colleges (AAMC), and Primary Care Progress (PCP), gives health professional students an unprecedented hands-on opportunity to learn and practice an innovative model of health care delivery called hotspotting.
Hotspotting, developed for use in health care by family physician Jeffrey Brenner (top left) of CCHP, identifies health care super-utilizers and invests more time and resources in them in order to keep them out of the hospital. Brenner was inspired by the method former NYPD Commissioner William Bratton devised to cut crime in New York City. He focused more resources in the areas that had heavier crime.
In health care, super-utilizers are admitted to the hospital multiple times a year, frequently for avoidable complications of chronic conditions, and often have social barriers to adhering to their care plan. Hotspotting proactively brings additional attention and follow-up to these patients to ensure, for example, that they are taking their medications correctly and maintaining other habits that keep them well. Through hotspotting, health care providers see these patients in their homes and communities, which provides deep insight into why they might be so sick in the first place.
“You get a very skewed view of patients in the hospital or at a medical office. There’s a power differential and patients are intimidated,” Brenner says. “It’s easy to misunderstand why patients are admitted to the hospital or not taking care of their illnesses. We need to teach students a broader perspective.”
In the hospital, it may appear that a patient was admitted because he made the poor decision to stop taking his medication. A visit to the patient’s home, however, could reveal that he doesn’t have transportation to a drug store to refill prescriptions or that he barely has food in the refrigerator, much less the co-pay for a prescription.
Brenner has brought this perspective to medical assistants whom he has led in implementation of the care model, but health professional students have never been trained in this model. “Care coordination of complex patients is extremely challenging work. It requires a very different set of skills than students normally learn,” Brenner says. “We’re going to need to shift the standard curriculum in various types of training programs to incorporate this new skill set.”
Members of the hotspotting cohort will learn how to identify super-utilizers through data analysis; how to engage with patients, families and community resources; and disease-specific intervention plans, among other skills.
The need to train a workforce that can address the needs of complex patients has never been greater. “Health care is increasingly focused on achieving the triple aim of improving patients’ experience of care and health outcomes while simultaneously lowering costs,” says Clese Erikson (top right), senior director of the AAMC’s Center for Workforce Studies. “Rethinking how we care for super-utilizer patients is an essential component of care redesign.”
That there are patients who are hospitalized dozens of times per year, for issues that could have been prevented, reflects a broken health care system. Students see the cracks in the system every day. This project will allow them to do something about it.
“These students see health system failures in their normal clinical rotations: errors of omission and commission, like failure to coordinate a patient’s care or failure to educate patients about their own health conditions,” says general internist Andrew Morris-Singer, co-founding president of PCP. “This project gives students the opportunity to get off the bench and onto the playing field to improve a system that has been failing so many of our most complex patients for so long.”
Forming ten teams, members of the hotspotting cohort, who come from 12 professions at ten schools, will spend six months with super-utilizer patients in their community.
“Really getting to know a few patients well, seeing where they live, going with them to medical appointments, and gaining first-hand experiences of the challenges they face,” Erikson says, “will give students a deeper understanding of the role that transportation, housing, food security and other social needs can play in patient health. We hope this knowledge will shape how they care for patients throughout their medical careers.”
The program aims not only to broaden students’ understanding of patients but also understanding of their colleagues across professions.
“One of the skills essential to the next generation of primary care leaders will be the ability to form and sustain teams of diverse health professionals that can solve real world problems,” says Morris-Singer. “The hotspotting project is a space for an interprofessional cohort of students to develop important leadership and communication skills and harness those skills to make a difference in the care and health of real people.”
Sonya Collins is a freelance journalist who covers health care and medical and scientific research. She is the consulting editor of Progress Notes, Primary Care Progress’s twice-weekly blog dedicated to primary care transformation, where this post originally appeared.