Posted: 10/17/2018
Collaboration with community aims for ‘better, smarter, healthier’ care
Why would you visit a hospital emergency room 85 times over a four-month period? For a 54-year old homeless Dallas patient seeking shelter and healthcare, frequent visits to Parkland Health & Hospital System’s ER offered hope. Patients like ‘Ms. R,’ known in the industry as ‘high ED (emergency department) utilizers,’ are part of a large, vulnerable population of uninsured patients with complex health and social needs. Often, they use the ER as a portal for care that could be provided more efficiently in another setting.
As Dallas County’s public safety net entity, Parkland provides more than X-rays, stitches and medications for these patients. Like many hospitals across the U.S. with increasing numbers of high ED utilizers, Parkland staff works with these patients to address underlying socio-economic problems - connecting them with resources for housing, food, transportation, job training or substance use disorder issues, for example. The result is better health outcomes for patients and improved financial health for hospitals.
Parkland’s programs to impact high-ER utilization have seen positive results. Multidisciplinary teams comprised of hospital and outpatient clinic physicians, nurses, chaplains, social workers and administrators have formed the Parkland High ED Utilizer Affinity Group to strengthen intra-organizational collaboration.
Now the system is expanding collaboration with other healthcare systems and community based organizations (CBOs) to collectively leverage health and social service resources for the highly vulnerable across Dallas County through the formation of the Collaborative Coalition for Collective Community Health Impact (CCCCHI).
“The purpose of collaboration is to reduce emergency room visits among high ED utilizers at area health systems and improve our collective community health. We have the opportunity to positively influence the lives of Dallas County residents to prevent serious health issues rather than waiting for the downstream detection of disease and chronic illness,” said Esmaeil Porsa, MD, MBA, MPH, CCHP-A, Parkland’s Executive Vice President and Chief Strategy and Integration Officer.
Recently Parkland conducted a series of multi-organizational studies across Dallas-Fort Worth area health systems to examine high ED utilization patterns and patient characteristics in order to identify opportunities for the Collaborative Coalition. Analyses determined that 80 unique patients are the same high ED utilizers at four of the largest area health systems, accounting for a total of 5,139 ED visits during a 12-month period across all four health systems with a total average estimated cost of $14,014,053.
The findings are in keeping with national surveys. According to a report by Kaiser Health News, patients with multiple chronic illnesses, many of whom frequently use emergency services, account for just 5 percent of patients but consume almost 50 percent of all healthcare resources.
By expanding their collaborative efforts, area hospitals and agencies hope to significantly affect the health of these most vulnerable patients and reduce the total cost of care. Based on the success of a variety of internal initiatives at Parkland, leaders there are optimistic that significant progress can be achieved. They point to successful interventions with numerous patients identified as high ED utilizers that have dramatically reduced their ER visits.
In the case of Ms. R, Parkland staff evaluated her needs and referred her to a social worker at a Parkland outpatient specialty clinic where she was being treated. The clinic social worker determined that Ms. R was receiving social assistance at a nearby church and connected Parkland’s Faith Health Initiative chaplain, Freedom McAdoo, with the church pastor to secure temporary housing for the patient and agred to help her locate a long-term housing solution.
“Since this patient received assistance in finding housing, she has not returned to Parkland’s ER. She continues to receive care regularly at the Parkland outpatient specialty clinic and is doing much better. As the saying goes, ‘it takes a village.’ Together we can do more for these patients than we can individually,” McAdoo said.
The ultimate goal of the new CCCCHI community-wide collaboration is to launch innovative initiatives to significantly impact community health upstream.
“We’re helping these patients avoid unnecessary ED visits and improve their health and well-being by assessing and meeting their needs efficiently and effectively,” said Marilyn Callies, Senior Vice President, Transitional and Post-Acute Services at Parkland. “It’s a smarter, better way to provide healthcare services.”
For more information about Parkland, visit www.parklandhospital.com