Clinical question: Does developing individualized care plans in the inpatient setting reduce unnecessary ED visits, hospital readmissions, and hospital costs for frequent users of hospital services?
Background: High utilizers of healthcare services are recognized as medically and psychosocially complex and are at risk for adverse outcomes. Although they make up a small fraction of the patient population (1%), they have high rates of ED visits and hospital admissions and account for 21% of national healthcare spending and hospital costs.
Study design: QI intervention with retrospective pre-/post-intervention analysis.
Setting: Inpatient, tertiary academic medical center.
Synopsis: A multidisciplinary team integrated individualized care plans for 24 high utilizer patients into the EHR from August 1, 2012, to August 31, 2013. These plans summarized medical, psychiatric, and social histories, hospital utilization patterns, and management strategies, including connecting individuals to appropriate services. Outcomes were measured six and 12 months after implementation.
Hospital admissions decreased by 56% (P<0.001) and 50.5% (P>0.003); 30-day readmission decreased by 66% (P<0.001) and 51.5% (P<0.002); ED costs, ED visits, and inpatient length of stay did not change significantly. Inpatient variable direct costs were reduced by 47.7% and 35.8% (P=0.052) at six- and 12-month analysis, respectively.
Bottom line: Individualized care plans developed by a multidisciplinary team and integrated into the EHR at the time of hospitalization can reduce hospital admissions, 30-day readmissions, and hospital costs for high-utilizing patients.
Citation: Mercer T, Bae J, Kipnes J, Velazquez M, Thomas S, Setji N. The highest utilizers of care: individualized care plans to coordinate care, improve healthcare service utilization, and reduce costs at an academic tertiary care center [published online ahead of print April 9, 2015]. J Hosp Med. doi 10.1002/jhm.2351