Generating Hypotheses About Care Needs of High Utilizers: Lessons from Patient Interviews

Mautner, Dawn; Pang, Hauchie; Brenner, Jeffrey; Shea, Judy A.; Gross, Kennen S.; Frasso, Rosemary; Cannuscio, Carolyn C.

doi:10.1089/pop.2013.0033

Cited by 70 publications

(78 citation statements)

References 38 publications

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“…Previous research has highlighted that the caring competence of hospital staff is associated with positive care experiences for ED users (Gordon et al 2010;Mautner et al 2013;Welch 2010). Our findings of predominantly negative ED experiences among our participants, in the context of perceived lack of caring by hospital staff, are therefore not surprising.…”

Section: Discussionsupporting

confidence: 61%

“…The experiences of frequent users as an undifferentiated group have been examined qualitatively (Malone 1996;Mautner et al 2013;Olsson and Hansagi 2001), although as Mautner et al (2013) assert, ''the patient perspective is rarely represented'' in previous studies of this population. Similarly, while the subpopulation of frequent users with mental health and substance use concerns has been welldescribed (Byrne et al 2003;Doupe et al 2012;Minassian et al 2013;Vandyk et al 2013), research exploring their experiences of ED utilization-described in their own voices-is notably absent.…”

Section: Introductionmentioning

confidence: 99%

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“Hospital was the Only Option”: Experiences of Frequent Emergency Department Users in Mental Health

Wise-Harris

Pauly

Kahan

et al. 2016

Adm Policy Ment Health

100

135

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The experiences of individuals with mental illness and addictions who frequently present to hospital emergency departments (EDs) have rarely been explored. This study reports findings from self-reported, quantitative surveys (n = 166) and in-depth, qualitative interviews (n = 20) with frequent ED users with mental health and/or substance use challenges in a large urban centre. Participants presented to hospital for mental health (35 %), alcohol/drug use (21 %), and physical health (39 %) concerns and described their ED visits as unavoidable and appropriate, despite feeling stigmatized by hospital personnel and being discharged without expected treatment. Supporting this population may require alternative service models and attention to staff training in both acute and community settings.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

“Hospital was the Only Option”: Experiences of Frequent Emergency Department Users in Mental Health

Wise-Harris

Pauly

Kahan

et al. 2016

Adm Policy Ment Health

100

135

View full text Add to dashboard Cite

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“…The PNs were empathic and caring, forming relationships that could motivate patients to engage more fully in their health care. 38 Intervention patients trended toward higher rates of 7-day primary care follow-up and had significantly more outpatient appointments within 30 days, visits that could play an important role in preventing readmission. 39,40 The reduction in readmissions among those over 60 is similar to other effective post-discharge programs.…”

Section: Discussionmentioning

confidence: 98%

A Patient Navigator Intervention to Reduce Hospital Readmissions among High-Risk Safety-Net Patients: A Randomized Controlled Trial

et al. 2015

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BACKGROUND: Evidence-based interventions to reduce hospital readmissions may not generalize to resourceconstrained safety-net hospitals. OBJECTIVE: To determine if an intervention by patient navigators (PNs), hospital-based Community Health Workers, reduces readmissions among high risk, low socioeconomic status patients. DESIGN: Randomized controlled trial. PARTICIPANTS: General medicine inpatients having at least one of the following readmission risk factors: (1) age≥60 years, (2) any in-network inpatient admission within the past 6 months, (3) length of stay≥3 days, (4) admission diagnosis of heart failure, or (5) chronic obstructive pulmonary disease. The analytic sample included 585 intervention patients and 925 controls. INTERVENTIONS: PNs provided coaching and assistance in navigating the transition from hospital to home through hospital visits and weekly telephone outreach, supporting patients for 30 days post-discharge with discharge preparation, medication management, scheduling of follow-up appointments, communication with primary care, and symptom management. MAIN MEASURES: The primary outcome was in-network 30-day hospital readmissions. Secondary outcomes included rates of outpatient follow-up. We evaluated outcomes for the entire cohort and stratified by patient age >60 years (425 intervention/584 controls) and ≤60 years (160 intervention/341 controls). KEY RESULTS: Overall, 30-day readmission rates did not differ between intervention and control patients. However, the two age groups demonstrated marked differences. Intervention patients >60 years showed a statistically significant adjusted absolute 4.1 % decrease [95 % CI: −8.0 %, -0.2 %] in readmission with an increase in 30-day outpatient follow-up. Intervention patients ≤60 years showed a statistically significant adjusted absolute 11.8 % increase [95 % CI: 4.4 %, 19.0 %] in readmission with no change in 30-day outpatient follow-up. CONCLUSIONS: A patient navigator intervention among high risk, safety-net patients decreased readmission among older patients while increasing readmissions among younger patients. Care transition strategies should be evaluated among diverse populations, and younger high risk patients may require novel strategies.KEY WORDS: care transitions; continuity of care; health care delivery; patient safety; underserved populations. J Gen Intern Med 30(7):907-15

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“…Initial efforts helped identify several broad risk factors for high utilization patients: presence of comorbid medical conditions, limited access to care,(16) unstable medical relationships,(17) and coexisting mental health disorders. (18) However, this concept of high healthcare utilization patients has not been explored in depth in IBD.…”

Section: Introductionmentioning

confidence: 99%

Demographic and Clinical Predictors of High Healthcare Use in Patients with Inflammatory Bowel Disease

Click

Rivers

Koutroubakis

et al. 2016

Inflammatory Bowel Diseases

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Background Inflammatory bowel disease (IBD) is a heterogeneous chronic inflammatory condition requiring significant healthcare expenditure. Subgroups of individuals contribute disproportionately to spending. We aimed to determine demographic and clinical factors predictive of high healthcare expenditures for IBD patients followed over a multiyear period. Methods This was a registry analysis using a prospective observational, consented, natural history registry from a tertiary IBD center and associated medical charges, not including pharmacy expenses. The 100 patients with the highest medical charges (top 5%) were compared to the median 300 patients. Logistic regression determined demographic and clinical factors associated with high charge patients. Results IBD patients in the high charge group had significantly more unemployment (p<0.0001), black race (p=0.013), comorbid psychiatric illness (p=0.002), hypertension (p=0.01), diabetes (p=0.004), opiate use (p<0.0001), perianal involvement (p=0.002), penetrating disease (p<0.0001), and extensive colitis (p=0.01). In multivariate analysis unemployment (CD: OR 3.04; 95% CI 1.32–7.02; UC: OR 2.68; 95% CI 1.20–5.99), psychiatric illness (UC: OR 2.08; 95% CI 1.03–4.19), opiates (CD: OR 5.61; 95% CI 2.67–11.82; UC: OR 5.14; 95% CI 2.52–10.48), prior surgery (CD: OR 3.29; 95% CI 1.59–6.82; UC: OR 2.72; 95% CI 1.39–5.32), penetrating CD (OR 3.29; 95% CI 1.02–10.62), and corticosteroid requirement (CD: OR 3.78; 95% CI 1.86–7.65; UC: OR 2.98; 95% CI 1.51–5.90) remained independently associated with high charges. Conclusion High expenditure IBD patients were affected by more severe disease. The high prevalence of depression, anxiety, and chronic pain in these patients suggests the need for focused treatment of these comorbidities ultimately to reduce financial burden.

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Generating Hypotheses About Care Needs of High Utilizers: Lessons from Patient Interviews

Cited by 70 publications

References 38 publications

“Hospital was the Only Option”: Experiences of Frequent Emergency Department Users in Mental Health

“Hospital was the Only Option”: Experiences of Frequent Emergency Department Users in Mental Health

A Patient Navigator Intervention to Reduce Hospital Readmissions among High-Risk Safety-Net Patients: A Randomized Controlled Trial

Demographic and Clinical Predictors of High Healthcare Use in Patients with Inflammatory Bowel Disease

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