The highest utilizers of care: Individualized care plans to coordinate care, improve healthcare service utilization, and reduce costs at an academic tertiary care center

Mercer, Tim; Bae, Jon; Kipnes, Joanna; Velazquez, Maureen; Thomas, Samantha M.; Setji, Noppon

doi:10.1002/jhm.2351

Cited by 43 publications

(55 citation statements)

References 11 publications

(13 reference statements)

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“…Six and 12 months after the implementation of individualized plan of service, hospital admissions decreased by 56% (p<0.001) and 50.5% (p=0.003), respectively (8). Thirty-day readmissions decreased by 66% (p<0.001) at 6 months and 51.5% (p=0.002) at 12 months after care-plan implementation (8). Limitations of this study include its small sample size and the generalizability of the data to psychiatric patients given the studied patients were not on psychiatric units when the treatment plan was formulated.…”

Section: Discussionmentioning

confidence: 99%

“…One study evaluated the effect of individualized plan of service and the rate of hospital admissions and readmissions in 24 medically and psychosocially complex patients with high health care utilization. Six and 12 months after the implementation of individualized plan of service, hospital admissions decreased by 56% (p<0.001) and 50.5% (p=0.003), respectively (8). Thirty-day readmissions decreased by 66% (p<0.001) at 6 months and 51.5% (p=0.002) at 12 months after care-plan implementation (8).…”

Section: Discussionmentioning

confidence: 99%

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Improving Communication Between Patients and Providers Surrounding the Legal Basis for Admission

Loman

2016

AJP Residents' Journal

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Communication in health care is critical, more so in psychiatry. It could be called the art of psychiatry if neurobiology is the science of it. Although medical schools encourage learning scientific standards of disease and nomenclature, it is just as important to learn the essentials of effective communication. By refining the skills of communication, the treatment outcome could be positively influenced and a sustained therapeutic relationship can be achieved. Recently, medical education has recognized communication as the area that needs the most improvement. The Accreditation Council for Graduate Medical Education and the American Board of Psychiatry and Neurology have integrated communication as a subsection of the psychiatry milestone project. In the July 2015 edition of Psychiatry Milestones, it is recommended that psychiatry residents recognize failures in teamwork and communication as a cause of preventable patient harm (1). Psychiatry residency programs evaluate the development of communication skills on different levels. To achieve a level 2 in the category of patient safety and health care team, psychiatry residents are expected to use structured communication tools, such as checklists, and safe hand-off procedures to prevent adverse events (1). It was found that communication skills tend to decline during the time of medical training (2). Contributing factors identified include the "emotional and physical brutality" of medical training, which has been found to erode the pillars of communication (2). Currently, in the Psychiatry Milestone project 1, "Communication and Patient Safety" is a subheading under

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improving Communication Between Patients and Providers Surrounding the Legal Basis for Admission

Loman

2016

AJP Residents' Journal

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“…Based on available case report data, it is anticipated that this intervention is a cost-effective initiative that will reduce ED visits and hospital admissions through enhanced care coordination. 28,29 Long-term follow-up of patients post-TIP to evaluate health system use is in progress. The TIP model achieves synchronous connection of patients with multimorbidity and their PCPs in an interprofessional case consultation focused on what is most important to the patient.…”

Section: S61mentioning

confidence: 99%

Connecting People With Multimorbidity to Interprofessional Teams Using Telemedicine

et al. 2019

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PURPOSE Most models for managing chronic disease focus on single diseases. Managing patients with multimorbidity is an increasing challenge in family medicine. We evaluated the feasibility of a novel approach to caring for patients with multimorbidity, performing a case study of TIP-Telemedicine IMPACT (Interprofessional Model of Practice for Aging and Complex Treatments) Plus-a 1-time interprofessional consultation with primary care physicians (PCPs) and their patients in Toronto, Canada. METHODSWe assessed feasibility of the TIP model from the number of referrals from PCPs and emergency departments in Toronto, Canada; the intervention cost; and the satisfaction of patients, PCPs, and team members with the new model. One patient and PCP story highlights the model's impact. We also performed thematic analysis of written feedback. RESULTSA total of 76 patients were referred from 53 PCPs and 4 emergency departments, and 65 PCPs participated in TIP. All 74 patient survey respondents indicated TIP improved their access to interdisciplinary resources, and 97% reported feeling hopeful their conditions would improve as a result. Of 21 PCP survey respondents, 100% reported they would use TIP again, and 90% reported improved confidence in managing their patient's care. Of 87 team member survey respondents, 97% rated TIP as effective. Qualitative findings indicated benefits to both patients and health professionals. The cost was about 22% less than that of a 1-day hospital admission through the emergency department (C$854 vs C$1,088).CONCLUSIONS TIP is a feasible intervention in multiple primary care settings that gives patients an active role in their health management, supported by their team. The model effectively addresses the needs of the most complex patients and their PCPs.To read or post commentaries in response to this article, see it online at http://www.AnnFamMed.org/content/17/Suppl_1/S57.

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“…They found that 23 (96%) were either addicted to drugs or mentally ill, and 20 (83%) suffered from chronic pain. 4 Drug abuse among high users is becoming even more relevant as the opioid epidemic worsens. Given that most patients requiring high levels of care suffer from chronic pain and many of them develop an opioid addiction while treating their pain, physicians have a moral imperative to reduce the prevalence of drug abuse in this population.…”

Section: ■ What Drives High Costs?mentioning

confidence: 99%

High users of healthcare: Strategies to improve care, reduce costs

Siekman

Hilger

2018

CCJM

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A minority of patients consume a disproportionate amount of healthcare, especially in the emergency department. These "high users" are a small but complex group whose expenses are driven largely by low socioeconomic status, mental illness, and drug abuse; lack of social services also contributes. Several promising efforts aimed at improving quality and reducing healthcare costs for high users include care management organizations, patient care plans, and better discharge summaries.

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The highest utilizers of care: Individualized care plans to coordinate care, improve healthcare service utilization, and reduce costs at an academic tertiary care center

Abstract: BACKGROUND: High utilizers are medically and psychosocially complex, have high rates of emergency department (ED) visits and hospital admissions, and contribute to rising healthcare costs.

Cited by 43 publications

References 11 publications

Improving Communication Between Patients and Providers Surrounding the Legal Basis for Admission

Improving Communication Between Patients and Providers Surrounding the Legal Basis for Admission

Connecting People With Multimorbidity to Interprofessional Teams Using Telemedicine

High users of healthcare: Strategies to improve care, reduce costs

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