Improving Patient-Centered Care and Decreasing Utilization through Interprofessional Student Hotspotting
Interprofessional Student Hotspotting aims to address patients with complex medical needs, referred to as super-utilizers. Research shows that 82% of super-utilizers have multiple comorbidities, 41% have a serious mental health condition, and 30% report homelessness (Johnson et al, 2015). The average super-utilizer has four times more inpatient admissions, four to eight times as many readmissions, 30% longer and more expensive hospital stays than the average patient, and are the top 5% of Medicaid beneficiaries who account for 50% of all Medicaid costs (Jiang et al 2015). Our pilot project is a collaboration between the Camden Coalition, University of Montana, and the Complex Care Team at our local federally-qualified health center (FQHC). It aims to decrease super-utilizersÕ emergency department (ED) visits while improving health through patient-centered care and increased primary care engagement. By using student teams, we aim to increase student understanding of the importance of interprofessional collaborative practice and patient-centered care.
Two interprofessional teams were formed with students from the following professions: pharmacy, nursing, physical therapy, social work, speech language pathology, pre-medical sciences and public health. Through home-based, non-clinical interventions that address social determinants of health, teams worked to improve their patientsÕ quality of life, integrate medical, behavioral, and social care, and increase utilization of primary care services. Patient utilization of the ED and primary care was monitored before and during the program. The student experience was assessed using the Interprofessional Attitudinal Scale (IPAS) and Student Perception of Interprofessional Clinical Education Ð Revised (SPICE-R).
During the program, teams worked with four patients whose care was facilitated by warm hand-offs from the Complex Care team. In the 6 months prior to the program, patients averaged 5.25 ED visits (range 2 -10 visits). Historically, during winter months, two of the patients visit the ED 3-7 times and missed appointments with their primary care team. The program ran September to March and patients had zero ED visits and demonstrated increased appropriate utilization of primary care services. The students increased their understanding of other health professions and improved team communication. One student noted ÒI appreciate learning about all the different roles and responsibilities of each profession and how they work with my own. I also appreciate understanding and approaching healthcare in a completely unique and holistic way.Ó (Post-test results on the IPAS and SPICE-R were delayed due covid-19 pandemic but will be available by May.)
Conclusions/Relevance to the conference theme:
Through engagement with interprofessional student hotspotting teams, patients had improved health outcomes and decreased utilization of the ED. Students gained real-world experience with patient-centered care and interprofessional teams. Interprofessional Student Hotspotting is an educational tool to support IPE and training in patient-centered care while improving health outcomes and decreasing healthcare expenditures in super-utilizers.