Interprofessional Student Hotspotting: Impact of Federally Qualified Health Centers (FQHC) on Complex Patients
Alexis Amendola, Pallavi Chary, Andrew Day, Graziella Holland, Michelle Murray, and Jesse Simpson
Individuals with complex health and social needs drive much of the total cost of care, accounting for nearly 50% of annual costs. Studies show that patients’ use of community health centers is associated with lower health care costs, less frequent use of emergency departments, and fewer preventable hospitalizations, compared to patients who do not use the health centers. Federally qualified health centers (FQHCs) provide patients with medical homes where they can build ongoing, personal relationships with treatment teams, resulting in continuous, comprehensive and integrated care.
Additionally, addressing these individuals' needs and decreasing costs requires interprofessional teams to engage with communities with high utilization rates. Training students of the health professions in the hotspotting approach will reduce utilization and costs.
Student Hotspotting is an educational curriculum originally developed by the Camden Coalition of Healthcare Providers to improve delivery of care for complex patients. This program facilitates teams of interprofessional students learning about the challenges faced by complex patients during their interactions with the current healthcare system. The curriculum focuses on the COACH framework as a means to empower patients to address their health needs effectively.
Interprofessional Student Hotspotting Learning Collaborative: A Student Initiative to Together Help Patients in Tangible and Intangible Ways
Kristin Brannon; Saskia Levy-Sheon; Michael Murphy; Megan Rankel; Caroline Christianson; Carly Alexander; Tejash Patel; Mariana Kuperman, MD; and Leigh Ann Hewston, PT, DPT, MEd, CEEAA
The Interprofessional Student Hotspotting Learning Collaborative brings together a team of students who work closely with individual patients with complex medical histories who are “super-utilizers” of health care resources.
- Provide a targeted, patient-centered approach to patient care
- Learn about our patient’s health from their perspective and develop a plan based on the patient’s goals and perceived needs
- Minimize misuse and miscommunication that had previously hindered the patient healthcare experience.
- Bring unique perspectives from each of our respective disciplines to improve upon inefficiencies in care
- Our team consisted of students from the colleges of Occupational Therapy, Physical Therapy, Nursing, Pharmacy, and Medicine
Steven Elsesser, MD; Elizabeth Feeney, BSN; Katherine Petty, SPT; Kevin Shaloo, SPT; and Nancy Tang, PharmD
The purpose of the Student Hotspotting initiative is to identify these individuals, understand their barriers and intervene by:
- Connecting them with community resources
- Improving coordination and communication between both providers and the patient
- Empowering these individuals to better manage their health
Our patient (DW) lives in a close-knit, 4-generation household that just welcomed their newest member: a black-and-white kitten
DW is a 61 year-old female who recently received orthotopic heart transplant. Her comorbidities include sleep apnea, GERD, OA, chronic pain syndrome, COPD and a history of a CVA
We identified 3 main barriers to address with DW
- Transportation difficulties
- Management of her complex medication regimen
- Maintaining a heart healthy lifestyle through diet and exercise
Interprofessional Perspectives: Challenges & Lessons Learned from Participation in the Student Hotspotting Program
Alex Faus, BS; Jennifer Newman, BA; Stephanie Quist, BM; John Ra, BS; Madeline Runyen, BA; and Kelsie Wilhelm, BSFS
By participating in the Student Hotspotting Program, students learned that:
- Coordinating the care of a complex patient requires an interprofessional team
- Hotspotting interventions can often be complicated by uncontrollable circumstances
- Building trust is key to working with patients who may be hesitant to engage with the healthcare system
- Successful interprofessional healthcare teams are characterized by specific attributes
- As future healthcare practitioners, we can apply these lessons into our own interprofessional interactions to optimize our treatment plans for complex patients
Brianna Gomez; Mirna Rezkalla; Daisy Yan; Krystal Park; and Amy Lachewitz, MD
- Hotspotting is a program focusing on providing interprofessional care to patients with complex medical and social needs using a patient-centered approach.
- Hotspotting program provides an opportunity for students from various healthcare programs to coordinate and offer individualized interventions to reduce ED admissions in “high-utilizers.”
- Our team consisted of students from: physical therapy, medicine, pharmacy, and occupational therapy programs.
Richard Jeffries, Lydia Glick, Katherine O'Rourke, Mi Bui, Jennifer Morelli, Katherine Cambareri, Florencia Campbell, Miranda Aragon, and Tracey Vause-Earland
About the Student Hotspotting Program:
A team of interdisciplinary students working with patients with complex medical and social needs
Identify "super-utilizers" of the healthcare system
- These patients frequently use the Emergency Department as primary source of medical care
- A "super-utilizer" of the ED is costly to the patient and system
- Build relationships
- Identify needs and goals
- Provide support to navigate healthcare system and increase independence
Adam Myer; Allyson Psillos; Brianna Brown; Anne Bono; Stephen Kern, PhD, OTR/L, FAOTA; Jamie Smith; and Michele Zawora, MD
United States Healthcare Dilemma
In the United States, a large proportion of healthcare resources and costs are utilized by a small percentage of the population.
- Approximately 25% of the United States healthcare costs are incurred by 1 percent of the population, while 5% are of healthcare costs are incurred by 50% of the population. The small percentage of the individuals who consume large amounts of resources has led to the term “super-utilizers.”
- These patients usually have complex and hard-to-manage conditions, as well as socioeconomic barriers to care, which frequently lead to potentially avoidable emergency department and hospital admissions and complications.
Potential Remedy: Hotspotting
Hotspotting is a new model of care by which healthcare professionals attempt to identify and better address the needs of super-utilizers.
Through electronic medical records and other data means, these patients are identified so that there can be additional resources allocated to them through a multi-disciplinary and coordination of care approach that addresses their medical needs.
Sean O'Sullivan, Rebecca Schuck, Sean Tonnesen, Gabrielle Sallade, Emily Osisek, and Avninder Ubhi
Healthcare spending in the U.S. reached $3.5 trillion in 20171. Half of this spending was due to only 5% of patients. Hotspotting is the practice of identifying high-utilizing patients and providing them ancillary care. Supporting such patients with nutrition information, care coordination, clinician communication, health education, and treatment adherence coaching benefits the patients, clinicians, and healthcare system. The Jefferson Interprofessional Student Hotspotting Program places students of different educational programs into teams to identify high-utilizing patients and provide them individualized and holistic care. It is an intimate longitudinal clinical experience for students and an opportunity to improve the health of complex patients.
Nethra S. Ankam, MD; Anne Mitchell, PhD, ANP-BC; Sarah Dallas, BA; Sarah Libros, BA; Tracey Vause Earland, PhD, OTR/L; Lauren Collins, MD; and Elena Umland, PharmD
Patient advocacy, essential to optimal team-based care, is included in the accreditation standards for many professions. Advocacy is an ideal vehicle for interprofessional education. Implemented since 2007, the Jefferson Health Mentors Program (HMP) is a required longitudinal program for first and second-year students from:
- Couple and Family Therapy
- Human Genetics and Genetic Counseling
- Medical Laboratory Science
- Occupational Therapy
- Physical Therapy
- Physician Assistant Studies
Christine A. Arenson, MD; Elizabeth T. Speakman, EdD, RN, ANEF, FNAP; Lauren Collins, MD; Shoshana Sicks, MEd; Sarah Ballas, BA; Abigail Sherburne, BS; and Catherine Mills
To promote excellence in healthcare through interprofessional education and scholarship.
JCIPE will define the future of interprofessional care by creating a culture of collaborative educational practice, setting the standards for patient-centered care and team-based training, and becoming a national/international leader in developing an evidence-base to support interprofessional education.
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