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Related Concept Videos

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The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
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Specialized care provided over an extended period is called tertiary care. Usually, a primary or secondary care physician will refer a patient to tertiary care. A patient's maximum physical and mental function is restored in tertiary care, which is caused due to the impact of a chronic illness or condition. Tertiary care aims to achieve the highest level of functioning possible while managing chronic illness. For example, a patient who falls and fractures their hip will need secondary care...
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Patient-centered care involves delivering care beyond inpatient hospitalization. Reflective practice can enhance a patient-centered approach. Reflective practice is a process of reasoning that considers all aspects of the present situation, including practicalities, learning from personal practice, and consideration of patient needs. Patients appreciate care decisions made while considering their input. Involving the patient in their care provides the patient with a sense of contribution rather...
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Gather "Round": An Integrated Care Model for the Emergency Department Multi-Visit Patient.

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The Multi-Visit Patient (MVP) program reduced emergency department (ED) visits by 57% in high-utilizing patients by addressing complex medical, behavioral, and social needs through integrated care. This initiative highlights the crucial role of case managers in optimizing patient outcomes and reducing ED utilization.

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Area of Science:

  • Healthcare Management
  • Public Health
  • Clinical Interventions

Background:

  • Emergency departments (EDs) face significant strain from over 130 million annual visits, with nonurgent cases contributing to crowding and care delays.
  • High-utilizing ED patients often have complex, unmet medical, behavioral, and social needs that extend beyond emergent care.
  • The Multi-Visit Patient (MVP) program was developed to address the needs of patients with frequent ED use.

Purpose of the Study:

  • To implement and evaluate an Integrated Care Model, the MVP program, designed to reduce emergency department (ED) utilization among high-frequency visitors.
  • To identify, engage, and intervene with patients exhibiting 5 or more ED visits within a 12-month period.
  • To improve patient stability, wellness, and overall health outcomes by addressing underlying complex needs.

Main Methods:

  • The MVP program utilized an interdisciplinary team of ED leadership and case management (CM) to identify and engage high-utilizing patients.
  • Patients underwent comprehensive screenings for conditions including depression, falls risk, alcohol use disorder, caregiver support, and social determinants of health.
  • Interventions included connecting patients with outpatient specialists and community-based organizations.

Main Results:

  • Over 20 months, 221 high-utilizing patients were identified, with 89% successfully contacted and 78% engaging in the program.
  • Among 151 patients with complete engagement and utilization data, ED visits decreased by 57%.
  • Case managers played a pivotal role in coordinating care and addressing patient needs.

Conclusions:

  • The MVP program effectively reduced ED utilization in high-frequency patients by providing comprehensive, integrated care.
  • Case managers are essential in identifying and addressing the multifaceted needs of complex patient populations.
  • This model demonstrates a successful strategy for optimizing patient care and reducing the burden on emergency departments.