Originally published June 16, 2015
By Sonya Collins
For the second year, the Camden Coalition of Healthcare Providers (CCHP), Primary Care Progress (PCP), and the Association of American Medical Colleges (AAMC) are collaborating on the Hotspotting Mini-Grant Project. The initiative gives interdisciplinary teams of health professions students an unparalleled hands-on opportunity to learn and practice an innovative model of health care coordination called hotspotting. Here, program partners weigh in on why hotspotting is important and the new elements participants can expect this year.
“The average health professions student is told that their job is to shadow and wait their turn. This project gets them off the sidelines and engaged in a meaningful way,” says Andrew Morris-Singer, a general internist and president of PCP.
Hotspotting, developed for use in health care by family physician Jeffrey Brenner (top left), CEO 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, often for avoidable complications of chronic conditions. Social barriers often prevent them from 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 the Hotspotting Project, health care professions students see these patients in their homes and communities, which provides deep insight into why they might be so sick in the first place.
“Last year, students discovered the power of simple interventions, such as discovering that providing art supplies to a disruptive patient who was at risk of being kicked out of all local dialysis centers helped her to center herself and remain calm,” says Clese Erikson, senior director of the AAMC’s Center for Workforce Studies. “Or that a patient who had been labeled as non-compliant and possibly developmentally delayed was actually unable to hear the care plan but eager to comply.”
Through hotspotting, students gain insight into their patients that they might never get in an exam room. “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.”
The 2014 program was such a success that some participating schools are working to make hotspotting a part of their curriculum.
Students will work in multidisciplinary care teams again this year. The teams will identify super-utilizers from local hospitals and offer them care coordination in hopes of keeping them out of the hospital.
“The interdisciplinary teams are a strength of the program. Students learn what other professions have to offer and help pave the way for other interprofessional activities at their schools,” says Erikson.
This year, the program will also include leadership training for the health professions students. “Leadership is a key skill for change management and advocacy,” says Brenner. “This project hopes to equip students with the skills not only to understand vulnerable patients, but also to become advocates for changing how they receive care.”
Relational leadership – the model for the leadership training – empowers leaders to bring out the best in patients, teammates and entire teams. “That’s going to help these students as clinicians, innovators, and advocates,” says Morris-Singer.
The program kicks off in July with a conference that brings all the teams together in Camden, New Jersey. Program leaders anticipate the new cohort will build on the successes of the last one.
“It was amazing to see how much the students were able to accomplish and learn through the collaborative,” says Erikson. “They gained tremendous insight into the challenges patients can have with accessing care, and they developed skills and training they can apply throughout their careers.”