By Tricia Olaes
Originally published November 4, 2014
The 2014 Hotspotting Mini-Grant Project gives health professional students an unprecedented hands-on opportunity to practice an innovative model of care delivery called hotspotting. Hotspotters identify health care super-utilizers — people who are admitted to the hospital multiple times a year, frequently for avoidable complications of chronic conditions, and who often have social barriers to adhering to their care plan. The hotspotters proactively bring additional attention, follow-up, resources and care to these patients in their homes and communities to help keep them out of the hospital. Student hotspotters will share their experiences here twice a month for the rest of this year in “Notes from the Hotspotters.”
I excitedly opened my new email account inbox and saw the first list of potential patients to recruit. All were just names on an automated Excel spreadsheet, and I wondered which one of these individuals, strangers to me now, would be our hotspotting team’s first recruited patient. Our teamwork had already served us well, and here we were, finally beginning.
Interprofessional teamwork seems to be all the buzz these days. As a third-year medical student, I had interacted mostly with nurses on wards and sparingly had direct contact with pharmacists, social workers, physical therapists and other non-physician providers. I knew of them but knew only a few personally. I understood we all help patients in slightly different manners, but it seemed to me like we all individually provided little bits of services as needed like several input cords that disappeared into the black box of the health care system and produced an eventual effect on the patient. Don’t get me wrong — that mostly works, and I have always been amazed with how individual parts of a system can work in concert to amount to something greater than the mere sum of its parts. But such a system seems to yield predominantly one-way (provider to patient) communication, where a patient might receive differing advice from various their health care providers. Thus, when I learned about the opportunity to participate in the hotspotting project, in which interprofessional student teams practice care coordination for super-utilizers – some of the neediest patients in our health system – I was admittedly a bit daunted but also intrigued, curious, and excited to explore this novel approach to patient care.
As one of the first ten student teams in the nation to participate in the hotspotting cohort under the guidance of Dr. Jeffery Brenner – the family medicine physician who first adapted the concept of hotspotting for use in health care – of Camden Coalition; Primary Care Progress; and the Association of American Medical Colleges (AAMC); my team of four fellow students — one in social work, one in nursing, one in pharmacy and one in medical school — was excited to learn about the change we could incite and hotspotting’s approach to providing strong coordinated care not just to help but to empower particular patients. Our initial fuel was our curiosity and yearning to be a part of something wonderfully qualitative and patient centered, and we were impressed and additionally inspired by the passion Dr. Brenner and Primary Care Progress exuded. They helped inspire us and showed us we could do more than yearn; with our willingness to embark on this project, we too, as students, could be agents of real change in our community.
But how? We were at point A (no patients) and wanted to be at Point B (with a patient panel). We had to recruit patients. But how? Wandering the halls of the hospital was an option, but we wanted to be more efficient and structured than that. We needed to obtain a list of patients to potentially recruit. We tried what I now call “manual data mining,” which is about as fun as it sounds. Initially, we relied on staff from a particular practice to suggest patients, then manually looked them up via EHR, but many of the leads didn’t quite fit our criteria.
Each team member then contacted various faculty at their schools. Our physician mentor contacted staff from other ranks within the Virginia Commonwealth University’s Health System (VCUHS). We found enthusiastic experienced individuals willing to serve as advisors to help us with our project. We arranged a large meeting for students and faculty to introduce themselves and their current roles in the health system. We voiced our thoughts and shared our vision to select patients who fit certain criteria: more than two inpatient admissions in the last 12 months, primary care providers from certain practices within VCUHS. We shared our efforts and challenges thus far.
One of the nursing school faculty involved in a home-visiting program mentioned they received daily lists of admitted patients who are potential candidates for home visits. My team wondered aloud if a similar list could be fashioned for us, too. Another faculty member suggested that VCUHS’ Office of Health Innovation might be of help. Established in 2011 to assist in the development of health reform implementation activities and innovation strategies through research and projects, they had data and computer know-how to possibly help us. I felt a flicker of hope. A few days later, we learned it was possible, but to receive protected health information, we needed secure computers and special email accounts that only health system employees have. After a flurry of calls, emails, and inquiries to our institution’s health information team and an explanation about our project, we received secure email accounts and thus that glorious email with a list of potential patient recruits.
The work that went into achieving that first step demonstrated the power and utility of interprofessional teamwork. A team of diverse individuals with varying ranges of knowledge shared a goal and vision, which in itself is a rare opportunity. I believe we are fortunate to have that magic mix of motivated individuals – both students and our extended advisory team – who not only share a vision but are also excited and willing to contribute their knowledge, time, and ideas. Our hotspotting team spent countless hours trailblazing a process for our workflow. Starting wasn’t easy and certainly wasn’t a straight line from Point A to Point B, but as a student team, we are constantly in flux, actively communicating with each other, our patients, and our extended advisory team.
We started a few moths ago as a group of students who barely knew each other with a mere vision and idea, and now we are in the active work of hotspotting, partnering with our panel of five patients identified as super-utilizers with various social and medical needs that we are helping address. As I continue practicing hotspotting, I know there will be more issues to tackle. Though I might not have a clear-cut plan of action to immediately answer situations, I’m comfortable with the challenges that arise. Just as important as the bond we form with our patients are the bonds we form with each other as a team. Interdisciplinary teamwork is becoming an integral part of patient-centered care, and I will be fortunate to work with team members who are just as enthusiastic, genuine, and hardworking as the team members I am working with now.
Tricia Olaes is a Los Angeles native and a fourth-year medical student at Virginia Commonwealth University. She looks forward to matching into a family medicine residency in Spring 2015 and working with the underserved.