Cross-Continuum Tool Is Associated with Reduced Utilization and Cost for Frequent High-Need Users

Hardin, Lauran; Kilian, Adam; Muller, Leslie; Callison, Kevin; Olgren, Michael

doi:10.5811/westjem.2016.11.31916

Cited by 22 publications

(37 citation statements)

References 22 publications

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“…Grover [44] reported a 41% reduction in hospital charges. Hardin [45] reported 45% decline in gross charges and 47% reduction in direct expenses. Lin [35] found a 15% reduction in ED direct costs as a result of the intervention.…”

Section: Resultsmentioning

confidence: 99%

“…Some papers [32] reported a decrease in cost per patient per month as a result of the intervention. Dehaven [34] and Hardin [45] reported a decrease in direct (wages, salaries, materials) and indirect costs (administration costs, insurance and maintenance costs) as a result of the intervention. While Grover [44] reported a total decrease in programme costs which was due to a 49% reduction in visits attributable to the intervention.…”

Section: Resultsmentioning

confidence: 99%

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Costs and effects of interventions targeting frequent presenters to the emergency department: a systematic and narrative review

et al. 2019

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BackgroundPrevious systematic reviews have examined the effectiveness of interventions for frequent presenters to the Emergency Department (ED) but not the costs and cost-effectiveness of such interventions.MethodA systematic literature review was conducted which screened the following databases: Pubmed, Medline, Embase, Cochrane and Econlit. An inclusion and exclusion criteria were developed following PRISMA guidelines. A narrative review methodology was adopted due to the heterogeneity of the reporting of the costs across the studies.ResultsOne thousand three hundred eighty-nine papers were found and 16 were included in the review. All of the interventions were variations of a case management approach. Apart from one study which had mixed results, all of the papers reported a decrease in ED use and costs. There were no cost effectiveness studies.ConclusionThe majority of interventions for frequent presenters to the ED were found to decrease ED use and cost. Future research should be undertaken to examine the cost effectiveness of these interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Costs and effects of interventions targeting frequent presenters to the emergency department: a systematic and narrative review

et al. 2019

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“…Root cause analysis of the medical, psychiatric, social, and system issues contributing to patient instability is key to improving outcomes and gaps in the plan of care. 11 Translating the analysis and opportunities into the electronic medical record (EMR) in standardized root cause notes alerts all disciplines of opportunities to improve care delivery. 11 Engaging an interprofessional team in design, program oversight, and daily rounds offers many opportunities to expand the circle of expertise contributing to patient stabilization and efficient system redesign.…”

Section: Discussionmentioning

confidence: 99%

“… 11 Translating the analysis and opportunities into the electronic medical record (EMR) in standardized root cause notes alerts all disciplines of opportunities to improve care delivery. 11 Engaging an interprofessional team in design, program oversight, and daily rounds offers many opportunities to expand the circle of expertise contributing to patient stabilization and efficient system redesign. Reporting population data and outcomes and analyzing patterns in readmissions on a weekly basis facilitate rapid cycle attendance to process improvements that can change the system of care delivery for all patients.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical notes in a standard root cause template are entered in the inpatient EMR and in the primary care EMR to translate helpful information cross continuum. 11 Navigators and the BPCI program leadership team met weekly to analyze patient data and perform root cause analysis of readmissions to identify potential opportunities for process improvement. Information from patient interventions is rapidly translated into process improvements that would affect all patients, not only those in the BPCI program.…”

Section: Discussionmentioning

confidence: 99%

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Bundled Payments for Care Improvement

Hardin

Kilian

Murphy

2017

JONA: The Journal of Nursing Administration

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BACKGROUNDThe Centers for Medicare and Medicaid Services Innovation Center introduced the Bundled Payments for Care Improvement (BPCI) initiative in 2011 as 1 strategy to encourage healthcare organizations and clinicians to improve healthcare delivery for patients, both when they are in the hospital and after they are discharged. Mercy Health Saint Mary’s, a large urban academic medical center, engaged in BPCI primarily with a group of medical diagnosis-related groups (DRGs).OBJECTIVESIn this article, we describe our experience creating a system of response for the diverse people and diagnoses that fall into the medical DRG bundles and specifically identify organizational factors for enabling successful implementation of bundled payments.RESULTSOur experience suggests that interprofessional collaboration enabled program success.CONCLUSIONSAlthough still in its early phases, observations from our program’s strategies and tactics may provide potential insights for organizations considering engagement in the BPCI initiative.

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Primary Care Practice Structural Capabilities and Emergency Department Utilization Among High-Need High-Cost Patients

et al. 2022

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Primary Care Practice Structural Capabilities and Emergency Department Utilization Among High-Need High-Cost Patients Ani Bilazarian BackgroundPrimary care practices in the United States (US) are currently constrained in their ability to deliver high quality care due to population aging, insurance expansion, and an increasing prevalence of chronically ill patients. The nurse practitioner (NP) workforce plays a critical role in meeting the growing demands for primary care, particularly in rural and underserved areas.NPs are also more likely to deliver care to clinically and socially complex populations such as high-need high-cost (HNHC) patients. HNHC patients are adults who suffer from multiple chronic conditions and experience additional functional, behavioral, or socioeconomic needs.Despite comprising only 5% of the US population, HNHC patients account for nearly half of total health care expenditures and over 90% of Medicare expenditures. HNHC patients with behavioral health diagnoses such as depression or substance abuse face heightened challenges managing their conditions and consequentially have higher preventable spending and emergency department (ED) utilization compared to the overall HNHC population.Significant policy attention has been placed on enhancing primary care practices as a strategy to improve outcomes and reduce costs in HNHC patients. Structural capabilities are features of primary care practices (e.g., after-hours care or care coordination) which are needed to deliver high quality primary care and chronic disease management. Yet, to date little research has been done on structural capabilities in primary care practices where NPs deliver care to HNHC patients. The overall purpose of this dissertation is to understand how to enhance primary care delivery and structural capabilities to improve outcomes for HNHC patients. We have achieved the following specific aims: (1) Establish a clear definition of HNHC patients, (2) Identify existing primary care and payment models used among HNHC patients and evaluate their impact on ED utilization and costs, (3) Evaluate structural capabilities in NP primary care practices located in Health Professional Shortage Areas (HPSAs), and ( 4) Analyze the association between NP practice structural capabilities and ED utilization among HNHC patients with behavioral health conditions. Dissertation Chapters and Key FindingsChapter One includes an introduction to the landscape of current primary care delivery, the role of the NP workforce in expanding access, and the unique challenges of delivering care to HNHC patients. This chapter also discusses the conceptual framework guiding the dissertation, the specific aims of each study, and how each study will fill a gap in the literature.Chapter Two (Aim 1) consists of a concept analysis of HNHC patients using the Walker and Avant framework. Three subgroups of HNHC patients were identified: adults over the age of 65 who suffer from multiple chronic conditions with functional or behavioral health needs, the frail elderly,...

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Cross-Continuum Tool Is Associated with Reduced Utilization and Cost for Frequent High-Need Users

Cited by 22 publications

References 22 publications

Costs and effects of interventions targeting frequent presenters to the emergency department: a systematic and narrative review

Costs and effects of interventions targeting frequent presenters to the emergency department: a systematic and narrative review

Bundled Payments for Care Improvement

Primary Care Practice Structural Capabilities and Emergency Department Utilization Among High-Need High-Cost Patients

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