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Habitually wandering patients

L Pankratz1, J Jackson

  • 1Psychology Service (116B), Veterans Affairs Medical Center, Portland, OR 97207.

The New England Journal of Medicine
|December 29, 1994
PubMed
Summary
This summary is machine-generated.

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Repeatedly hospitalized "wandering patients" incur significant healthcare costs and require coordinated case management due to complex, often substance abuse and mental health-related, disorders.

Area of Science:

  • Healthcare Management
  • Patient Care Coordination
  • Health Services Research

Background:

  • Repeated hospital admissions, termed "wandering patients," present challenges in understanding patient needs and resource utilization.
  • Limited data exists on the characteristics, healthcare resource use, and associated costs of these patients.

Purpose of the Study:

  • To analyze the demographic and clinical characteristics of "wandering patients" within the Department of Veterans Affairs (VA) medical system.
  • To quantify the healthcare resource utilization and costs associated with these patients.

Main Methods:

  • Utilized VA administrative data from 159 hospitals nationwide.
  • Identified patients with four or more admissions to different VA medical centers (VAMCs) annually between fiscal years 1988 and 1992.

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  • Defined "wanderers" as patients admitted to multiple VAMCs in a year and "habitual wanderers" as those admitted to multiple VAMCs across all five years.

    • Main Results:

    • In 1991, 810 "wandering patients" averaged eight admissions and over 100 inpatient days, costing approximately $26.5 million.
    • Thirty-five "habitual wanderers" (admitted to multiple VAMCs for all five years) had diagnoses primarily related to substance abuse and mental disorders.
    • These "habitual wanderers" incurred an estimated $6.5 million over five years for 2268 admissions and 7832 outpatient visits.

    Conclusions:

    • "Wandering patients" experience fragmented care, diagnostic challenges, and high admission rates.
    • The complex nature of their conditions necessitates centralized case management strategies, potentially on a regional or national scale.