How Not to Handle Frequent Flyers
February 26, 2020
Written by Clay Smith
Spoon Feed
Deploying a team of healthcare professionals to assist patients with complex medical and social needs at hospital discharge did not reduce readmission rate.
Why does this matter?
Some patients are heavy utilizers of healthcare resources. Would surrounding these patients with a team of nurses, social workers, and community health workers reduce future healthcare utilization, namely readmission?
Frequent flyer fail
This was a RCT with 800 “superutilizer” patients with complex medical and social needs and frequent admission who were randomized to the Camden Coalition of Healthcare Providers “hotspotting” program (team described above) vs usual care upon hospital discharge. Camden is an economically challenged area in New Jersey. Patients in the program received a median of 7.6 home visits, 8.8 phone calls, and 2.5 primary visits. Yet, for the primary outcome of 180-day readmission, there was no difference: 62.3% hotspotting vs 61.7% control. The program also had no significant impact on downstream benefit participation in supplemental nutrition, temporary assistance for needy families, or general assistance. Clearly, this program is not the magic bullet for frequent flyers. A team of people doesn’t reduce the complex needs of such patients. It also shows that “usual care” is doing a good job connecting patients with resources. It may not be possible to reduce costs by reducing repeat hospitalization. This study shows why RCTs to evaluate such programs targeting “superutilizers” are important. Just because a patient is consuming vast resources today does not mean this will persist at such a high level. In fact, there was a regression to the mean, with both groups of superutilizers seeing a reduction in subsequent healthcare costs. An observational model would have appeared to show benefit which was not, in fact, real.
Source
Health Care Hotspotting – A Randomized, Controlled Trial. N Engl J Med. 2020 Jan 9;382(2):152-162. doi: 10.1056/NEJMsa1906848.
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Hospital ER’s should never put patients on frequent flyer lists. Unless a patient has been diagnosed as mentally ill. They put me on their list. The reason I know, is that I seen people come in 2 or more hours after me with a cough, when I had a serious spine problem. When the nurse came out to get me after a 4 hour wait, in the waiting room. She said, “Oh, sorry, you got put on the wrong list. I never abuse ER privileges. And it happened 2 times. Now when I need to go to ER, I try to treat my medical conditions other ways for days; before I will go to the ER. This is NOT right.