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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With this in mind, the dramatic results reported about programs like the Camden Coalition seem much less impressive.

But when independent researchers conducted a pre-planned evaluation of the program in which they compared enrolled patients with similar controls, atlu data told a different story. Because most coordinators had caseloads of well under patients, they were hoh to contact their assigned patients frequently — often sptoters times a month or more.

Gawande also describes a visit he made to the Special Care Center, a clinic in Atlantic City, an experimental approach to primary care. 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. To their credit, the Camden Coalition has acknowledged that the dramatic data initially reported about their program may be overblown.

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. What do we have in complex care?

The Hot Spotters by Atul Gawande |

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. One of the doctors that works for Verisk, Nathan Gunn, who explains the way data mining can be used to identify the most frequent users of health-care facilities and reduce their costs.

By providing follow-up consultation and care to such patients before they might otherwise seek further in-hospital care, “hot-spotting” aims not only to cut healthcare costs associated with repeated hospitalizations, but ultimately to improve the health of those most in need.


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. 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.

If Camden, New Jersey, becomes the first American community to lower its medical costs, it will have a murder to thank. You may use these HTML tags and attributes: For example, a program could be piloted in one clinic and compared with a nearby similar control clinic.

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

Fri, Jun 21st, New clinical and policy guidelines launched to guide Brenner’s group defines healthcare hot-spotting as “the strategic use of data to reallocate resources to a small subset of high-needs, high-cost patients. To rigorously assess their model, the Camden Sspotters is now participating in a randomized trial of their program. 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.

The most recent was about hospice care. Your email address will not be published. A Vision of Connected Health: By latehis team had provided care for more than three hundred of these most costly people. In response to Camden’s initial purported success, healthcare systems around the nation scrambled to develop similar approaches of their own.

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. 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.

Though enthusiasm for “hot-spotting” may be over-hyped, it is important to highlight that some programs have shown success, even in rigorous controlled evaluations.

He created a way to find the people whose use of medical care was highest, and go after them and provide better care. 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.

In the Hot Spotter article Gawande writes about several innovative ths to reducing health-care costs.

The Hot Spotters by Atul Gawande

As a atull, 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. The coordinators also focused their efforts on hospital-to-home care transitions and medication management.


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These people averaged 62 hospital and E. 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 thr the Rutgers University campus.

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

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. Chemistry has the periodic table, physics has Newtonian equations, biology has the theory of evolution.

The ideal study design for evaluating hot-spotting approaches, says Asch, is a randomized control trial. Its model utilizes “care teams” made up of health professionals with expertise in such disciplines as nursing, pharmacy, health coaching, counseling, social work, and community health work.

A neighborhood couple, a physical therapist and a volunteer firefighter, approached to see if they could help, but police waved them back. The paradigm — referred to as “hot-spotting” — has sprung up in dozens of places in the U. Fri, Jun 21st, Nobel peace prize winner Muhammad Yunus is no Keep Me Updated Signup to recieve latest updates and announcements.

Link to full text in the New Yorkert: Nearly everyone involved anticipated success, and indeed enrolled patients experienced substantial improvements in health and reductions in hospitalization rates. Cancer Patients and Social Media.

It turns out that we easily can hte tricked by simple analyses of programs targeting high-risk populations because of atl well-established — but counter-intuitive — statistical principle known as regression to the mean. We don’t understand what drives some patients to over-utilize healthcare services and others to under-utilize care. 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.

But for a mainstream doctor to say that proactive patient centered care saves money and is worthwhile is, I think, monumental.