Psychosocial characteristics of high utilizing inner city hospital patients

Abstract

Background and Aims:A relatively small proportion of patients account for a disproportionate share of healthcare utilization and cost with, on average, 1% of patients responsible for 20-25% of cost, 5% of patients for 40% and 10% for two thirds. These “high-utilizers” frequently suffer from co-morbid medical and psychiatric illnesses, but they are not well characterized in terms of diagnoses, current treatment patterns, or long-term outcomes. We sought to characterize further such patients at a large inner city acute care hospital.Methods:We applied a validated tool, Patients At Risk for Re-hospitalization, to the entire hospital population and then performed a mixed methods (quantitative/qualitative) study of 100 patients judged to be at high risk (>67%) of re-hospitalization during the ensuing year.Results:Of over 130,000 patients, 6,000 were identified. These individuals were overwhelmingly non-elderly adults (96% ages 18-64). Most common medical diagnoses were hypertension (49%), asthma (41%), diabetes (33%), and HIV/AIDS (32%). Schizophrenia, bipolar illness, or other psychosis was found in 48%. Over two-thirds had substance abuse diagnoses. Although 56% had made at least one emergency department visit in the past two years, only 37% had seen a primary care provider. Patient interviews revealed high rates of unstable housing, social isolation, and failure to appreciate the severity of health problems.Conclusion:High utilizers of general health care have very high rates of serious mental illness and substance abuse. Interviews suggest need for improved medical/psychiatric coordination with community outreach. Although such interventions are resource intense, the economic and health benefits may be large.