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{
    "pk": 10136,
    "title": "Cross-Continuum Tool Is Associated with Reduced Utilization and Cost for Frequent High-Need Users",
    "subtitle": null,
    "abstract": "Introduction: \nHigh-need, high-cost patients can over-utilize acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased US healthcare cost.\n \nOur objective was to reduce healthcare cost and improve outcomes by optimizing the system of care.  We targeted HNHC patients and identified root causes of frequent healthcare utilization.  We developed a cross-continuum intervention process and a succinct tool called a Complex Care Map (CCM)© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services.\n \n \n \nMethods:\n Using a pre/post test design, this quality improvement project focused on determining if the interdisciplinary intervention called CCM© had an impact on healthcare utilization and costs for HNHC patients.  Analysis was conducted between November 2012 and December 2015 at Mercy Health Saint Mary’s, a Midwestern urban hospital with greater than 80,000 annual emergency department visits.  Included patients had three or more hospital visits (ED or IP) in the 12 months prior to initiation of a CCM© (n=339).  Individualized CCMs© were created and made available in the Electronic Medical Record (EMR) to all healthcare providers. We compared utilization, cost, social, and healthcare access variables from the EMR and cost accounting system for 12 months before and after CCMs© implementation.  Both descriptive and limited inferential statistics were utilized.\n \n \n \nResults: \nED mean visits decreased 43% (p<0.001), inpatient mean admissions decreased 44% (p<0.001), outpatient mean visits decreased 17% (p<0.001), CT mean scans decreased 62% (p<0.001), and OBS/IP LOS mean days decreased 41% (p<0.001).  Gross charges decreased 45 % (p<0.001), direct expenses decreased 47% (p<0.001), contribution margin improved by 11% (p=0.002), and operating margin improved by 73% (p<0.001).  Patients with housing increased 14% (p<0.001), those with primary care increased 15% (p<0.001), and those with insurance increased 16% (p<0.001).\n \n \n \nConclusion: \nIndividualized CCMs© for a select group of patients are associated with decreased healthcare system overutilization and cost of care.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Complex Care Map©"
        },
        {
            "word": "high need patient"
        },
        {
            "word": "high frequency patient"
        },
        {
            "word": "complex patient"
        },
        {
            "word": "chronic patient"
        },
        {
            "word": "emergency department"
        },
        {
            "word": "individualized care"
        },
        {
            "word": "cross continuum care collaboration"
        },
        {
            "word": "electronic medical record, EMR"
        },
        {
            "word": "electronic health record, decrease readmissions"
        }
    ],
    "section": "Emergency Department Operations",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/6hf0g27g",
    "frozenauthors": [
        {
            "first_name": "Lauran",
            "middle_name": "",
            "last_name": "Hardin",
            "name_suffix": "",
            "institution": "Trinity Health-Michigan d/b/a Mercy Health Saint Mary’s, Grand Rapids, Michigan;\n\nNational Center for Complex Health and Social Needs, Camden, New Jersey",
            "department": "None"
        },
        {
            "first_name": "Adam",
            "middle_name": "",
            "last_name": "Kilian",
            "name_suffix": "",
            "institution": "Trinity Health-Michigan dba Mercy Health Saint Mary’s, University of Utah Healthcare",
            "department": "None"
        },
        {
            "first_name": "Leslie",
            "middle_name": "",
            "last_name": "Muller",
            "name_suffix": "",
            "institution": "Grand Valley State University",
            "department": "None"
        },
        {
            "first_name": "Kevin",
            "middle_name": "",
            "last_name": "Callison",
            "name_suffix": "",
            "institution": "Grand Valley State University",
            "department": "None"
        },
        {
            "first_name": "Michael",
            "middle_name": "",
            "last_name": "Olgren",
            "name_suffix": "",
            "institution": "Trinity Health-Michigan dba Mercy Health Saint Mary’s",
            "department": "None"
        }
    ],
    "date_submitted": "2016-07-31T23:17:13Z",
    "date_accepted": "2016-07-31T23:17:13Z",
    "date_published": "2016-12-09T08:00:00Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/10136/galley/5551/download/"
        }
    ]
}