Magazine article Clinical Psychiatry News

Care Plans Lower Visits to ED by High-Risk Patients

Magazine article Clinical Psychiatry News

Care Plans Lower Visits to ED by High-Risk Patients

Article excerpt

FROM THE ANNUAL MEETING OF THE SOCIETY OF HOSPITAL MEDICINE

SAN DIEGO -- "Ann" is a 35-year-old patient with a history of narcotics abuse, type 1 diabetes, borderline personality disorder, and severe anxiety disorder. In a span of 6 weeks, she had 14 visits to the emergency department and was admitted 6 times. In the 14 weeks after a care plan was started for Ann, she visited the ED twice and was admitted twice.

Ann is one of 28 high-risk patients who were identified by the HealthPartners Medical Group and received specialized care plans that are easily accessible via computer at presentation. In the 2 months since the plans were instituted, hospitalizations and emergency department visits for these patients have decreased from 122 ED visits and 59 admissions to 53 ED visits and 9 admissions, an overall reduction of about 65%, Dr. Richard J. Hilger and his associates reported at the meeting.

"Our financial department says that ideally, in a closed system, that would be a cost savings to society of over half a million dollars just for 28 patients over just a 2-month period," said Dr. Hilger, medical director of Care Management at Regions Hospital, St. Paul, Minn., a part of HealthPartners Medical Group.

Presently, there's no way of knowing if patients circumvented the care plans by going to another hospital that's not in the HealthPartners Medical Group, but records suggest that "only a handful of patients have left our system," he added.

The study was honored by the Society of Hospital Medicine as one of the best three presentations at the meeting.

The investigators next will try to integrate the care plans among health care systems in their geographic area, "so that care plans can be used from system to system," Dr. Hilger said.

The pilot study focused on three groups of patients with frequent ED visits and hospitalizations: narcotic-seeking patients, patients with mental health diagnoses (especially borderline traits), and patients with a long history of not complying with medical therapy.

A committee of hospital leaders created the specialized plans to restrict care in hopes of redirecting these patients to clinics and their primary care physicians, thus reducing medically unnecessary admissions and ED visits. The committee included specialists from hospital medicine, nursing, emergency medicine, primary care, risk management, quality control, care management, and electronic medical records. …

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