High‐need high‐cost patients: A Concept Analysis

Bilazarian, Ani

doi:10.1111/nuf.12500

Cited by 11 publications

(16 citation statements)

References 34 publications

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“…Contudo, cabe aos líderes atentar que tais transtornos mentais podem estar atrelados a casos de pacientes de alto custo. Casos de alto custo, além de proporcionar mais afastamentos, impactam negativamente na absorção dos recursos destinados à saúde 30 e, por sua vez, na sociedade.…”

Section: Discussionunclassified

Saúde Mental Do Trabalhador E O Alto Custo Da Assistência Médica: Uma Análise Por Meio Do Aprendizado De Máquina

Seleme¹,

Cubas²,

Carvalho³

2023

Rev. Foco

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Objetivo: Identificar variáveis de saúde mental do trabalhador relacionadas ao alto custo nos planos de saúde, por meio do aprendizado de máquina. Método: Pesquisa quantitativa, retrospectiva e de caráter descritivo, com dados administrativos de demandas por procedimentos de saúde de janeiro de 2019 a março de 2021, e de questionário de saúde, aplicado em outubro de 2020, de 586 trabalhadores, assistidos por um plano de saúde. A pesquisa compreendeu quatro etapas: (i) pré-processamento das bases de dados; (ii) construção do modelo com uso do algoritmo random forest; (iii) avaliação das variáveis preditoras, com base no método de importância de Gini; (iv) avaliação dos resultados por especialistas em gestão de saúde. Resultados: Variáveis relacionadas aos transtornos mentais: transtorno bipolar, uso de bebida alcoólica, ansiedade e depressão, foram identificadas como preditoras de casos de alto custo: transtorno bipolar, uso de bebida alcoólica, ansiedade e depressão aos casos de alto custo. Houve concordância dos especialistas quanto a relação destas variáveis com o desfecho alto custo. Considerações finais: Apoiar iniciativas de saúde nas empresas pode promover mudanças que impactam não somente na saúde dos trabalhadores, mas também na produtividade e resultados das organizações, ampliando a atuação de ambulatórios e de gestores de saúde ocupacional.

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Section: Discussionunclassified

Saúde Mental Do Trabalhador E O Alto Custo Da Assistência Médica: Uma Análise Por Meio Do Aprendizado De Máquina

Seleme¹,

Cubas²,

Carvalho³

2023

Rev. Foco

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“…Chapter Two: The concept analysis was conducted to provide a comprehensive definition of HNHC patients (Bilazarian, 2020). The Walker and Avant Framework (2019) consists of a review of the literature to identify all uses of the concept, determine defining attributes and antecedents and consequences, and construct model and alternative cases of the concept.…”

Section: Discussion Of Principal Findingsmentioning

confidence: 99%

“…This review can educate ED nurses on the effectiveness of a variety of primary care models and encourage nurses to engage in conversations with HNHC patients surrounding the availability and quality of primary care models at their practices. Further, the ED setting is an ideal point of intervention for nurses to conduct a comprehensive assessment of the unique medical and psychosocial needs of a HNHC patient and advocate for specific resources (e.g., care coordination, case management) or consultation (e.g., psychiatry, social work, or podiatry) in real time (Bilazarian, 2020;Billings & Raven, 2012).…”

Section: Implications For Ed Nursesmentioning

confidence: 99%

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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“…These diseases are responsible for $3.8 trillion in annual healthcare costs and are the leading causes of high care requirement, death, and disability; moreover, about 50% of index hospitalizations (referred to hospitalizations with procedures performed on patients; Ejaz et al, 2016 ) are readmissions (referred to rehospitalizations within 30 days of discharge from index hospitalizations; Ejaz et al, 2016 ) or nonindex hospital readmissions (referred to readmissions with different hospital ID numbers for the initial hospitalization and readmission; Chappidi et al, 2017 ) within 30 days of discharge (Brunner‐La Rocca et al, 2020 ; CDC, 2021 ). One reason chronic illness care is in such a state of crisis is care fragmentation, or the state of limited, noncontinuous, episodic, and disorganized care across multiple healthcare practitioners and settings (Bilazarian, 2021 ; Joo, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

Fragmented care and chronic illness patient outcomes: A systematic review

Joo

2023

Nursing Open

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Aim This systematic review examined recent studies on fragmented care of patients with chronic illnesses in the United States to examine the association between fragmented care and patient outcomes. Design Systematic review. Methods Studies published from January 1, 2012, to June 1, 2022, were selected from four electronic databases (PubMed, CINAHL, PsycINFO, and Web of Science), following the Cochrane protocols and PRISMA statements. Based on inclusion and exclusion criteria, ten studies that examined associations published between 2015 and 2021 were selected. A methodological assessment was conducted with the Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. The studies selected for this systematic review were rated as having fair methodological rigor. The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42021285379). Because of the heterogeneity of the selected studies' data, a systematic narrative synthesis of the extracted data was conducted. Results Three common measures for fragmented care and outcomes were synthesized. A synthesis of the studies found significant association between fragmented care and adverse outcomes of chronic illnesses (emergency department visits, utilization of diagnostic tests, and healthcare costs). Despite the heterogeneity of significant findings between fragmented care and patient outcomes, the relationship between these outcomes and fragmented care was significant. This systematic review provides clear evidence of the association between care fragmentation and its adverse effects on individuals with chronic illnesses. However, mixed relationship findings were also reported. Conclusion Given the demands of overcoming fragmented care in healthcare settings in the United States, nurse managers, healthcare leaders, and policymakers should utilize this evidence to reduce fragmented care strategies. It is recommended that nurse researchers and other healthcare practitioners conduct further studies to understand the contexts and mechanisms of fragmented care and develop theoretical frameworks for care fragmentation and chronic illness outcomes.

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High‐need high‐cost patients: A Concept Analysis

Cited by 11 publications

References 34 publications

Saúde Mental Do Trabalhador E O Alto Custo Da Assistência Médica: Uma Análise Por Meio Do Aprendizado De Máquina

Saúde Mental Do Trabalhador E O Alto Custo Da Assistência Médica: Uma Análise Por Meio Do Aprendizado De Máquina

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

Fragmented care and chronic illness patient outcomes: A systematic review

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