Atul Gawande’s refers to them in his New Yorker piece as The Hot Spotters. Just as law enforcement in community policing identifies crime. Can we lower medical costs by giving the neediest patients better care? If Camden, New Jersey, becomes the first American community to. New Yorker. Jan The hot spotters: can we lower medical costs by giving the neediest patients better care? Gawande A. PMID: ; [Indexed .

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Gawande then describes the difficulties in implementing these and other innovative ideas on a larger scale, including opposition from insurance companies and the health-care lobby. Wed, Jul 10th, Having heard Clay Christensen expound on disruptive Brenner’s group defines healthcare hot-spotting as “the strategic gawandr of data to reallocate resources to a small subset of high-needs, high-cost patients.

The hot spotters: can we lower medical costs by giving the neediest patients better care?

The paradigm — referred to as “hot-spotting” — has sprung up in dozens of yot in the U. Leave a Reply Cancel reply Your email address will not be published. To their credit, the Camden Coalition has acknowledged that the dramatic data initially reported about their program may be overblown.

The study concluded that, relative to controls, “these programs had favorable effects on none of the adherence measures and only a few of many quality of care indicators examined,” and did not favorably impact the costs of care.

With our background practicing naturopathy, much of what Gawande describes seems so obvious, kind of preaching to the choir. Your email address will not be published. Link to full text in the New Yorkert: Can we lower medical costs by giving the gawwnde patients better care?

As a result, many “super-users” of hospital facilities today are likely to stop being high-volume users in the future, regardless of whether they receive intensive targeted services — often referred to as “complex care management” — or not.

Chemistry has the gawanxe table, physics has Newtonian equations, biology has the theory of evolution. A pile of meaningless terms and poorly tested ideas. This second article in the series explains why targeted programs for high needs, high cost patient populations may not be achieving their intended goals.

Even when a randomized trial is not feasible, however, the rigor of a complex care management program evaluation can be enhanced by the inclusion of a matched contemporaneous control population. He created a way to find the people whose use thee medical care was highest, and go after them and provide better care.


Without rigorous research to determine the exact impact of such programs, practitioners and patients alike cannot assume that complex care management is the primary reason for any improvement of such high-use patients, says Steven Asch, MD, professor of medicine at Stanford University and an expert in the field. Boeing funded a specialized intensive outpatient clinic for these employees with a dedicated physician and nurse care manager, who oversaw the care of to high-risk patients.

The most recent was about hospice care.

The Hot Spotters by Atul Gawande |

While emergency room visits, hospitalizations, and overall costs among enrolled patients may have dropped substantially, there is no telling whether patients would have experienced these same improvements even without the program. Keep Me Updated Signup to recieve latest updates and announcements. The ideal study design for evaluating hot-spotting approaches, says Asch, is a randomized control trial.

But upon closer inspection, careful analysis of the Camden program and others like it raises concerns that these apparent jaw-dropping improvements may be overstated. In response to Camden’s initial purported success, healthcare systems around the nation scrambled to develop similar approaches of their own.

In the Hot Spotter article Gawande writes about several innovative approaches to reducing health-care costs. Fri, Jun 21st, New clinical and policy guidelines launched to guide At nine-fifty on a February night ina twenty-two-year-old black man was shot while driving his Ford Taurus station wagon through a neighborhood on the edge of the Rutgers University campus.

Recent efforts by the Camden Coalition and other similar-minded innovators have inspired a much-needed renewed focus on the most complex patients in our healthcare system.

The hot spotters: can we lower medical costs by giving the neediest patients better care?

Brenner used data mining and statistical analysis to map health-care use and expenses. Cancer Patients and Social Media. Another example of a successful complex care management effort was a program for high-risk older adults in Pennsylvania led by an organization called Health Quality Partners as part of the same Medicare demonstration described above. Many of the atull rigorous studies of “hot-spotter” approaches have come to similar disappointing conclusions.

And he does it so well…. You can listen to the interview at: The best I can do for now is summarize the article and encourage you to either purchase the issue or read it online at a later date. After an initial intake visit, the team contacts enrolled patients at a minimum of twice monthly. It turns out that we easily can be tricked by simple ayul of programs targeting high-risk populations tye of a well-established — but counter-intuitive — statistical principle known as regression to the mean.


These people averaged 62 hospital and E. Links to all articles in the series are available on the Gehr Center and Updates in Slow Medicine websites. While it is too early to report data or to draw conclusions from that study, these results should provide insights about the program’s true impact. When Jeffrey Brenner, MD, took notice more than a decade ago of the spotty care afforded certain high-risk, high-need patients in Camden, N.

The patients were also markedly healthier. But when independent researchers conducted a pre-planned evaluation of the program in which they compared enrolled patients with similar controls, the data told a different story. Yet it is clear these efforts are falling short of expectations, and much more work — and rigorous evaluation — will be needed to deliver on the promise of better, more efficient care for this population.

Unlike other less successful programs in that demonstration, the care coordinators had regular in-person interaction with their assigned patients and were closely connected with their patients’ primary care providers. A Critical Look at Healthcare Delivery Reform” unpacks the data behind healthcare delivery system interventions, highlighting well-intended reforms that have yet to achieve the impact many have assumed.

What do we have in complex care? If Camden, New Jersey, becomes the first American community to lower its medical costs, it will have a murder to thank.

Very few of these programs have reached the level [of success] I would consider convincing,” he said.

Gawande also describes a visit he made to the Special Care Center, a clinic in Atlantic City, an experimental approach to primary care. The coordinators also focused their efforts on hospital-to-home care transitions and medication management.