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 .

Author: Gugul Tokree
Country: Sri Lanka
Language: English (Spanish)
Genre: Sex
Published (Last): 9 August 2006
Pages: 371
PDF File Size: 18.80 Mb
ePub File Size: 13.41 Mb
ISBN: 583-7-64534-380-5
Downloads: 15647
Price: Free* [*Free Regsitration Required]
Uploader: Dukus

The ideal study design for evaluating hot-spotting approaches, says Asch, is a randomized control trial.

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

Calibrating the ‘Hot-Spotting’ Hype

These people averaged 62 hospital and E. Because most coordinators had caseloads of well under patients, they were able to contact their assigned patients frequently — often several gzwande a month or more.

Very few of these programs have reached the level [of success] I would consider convincing,” he said. Joel Greenberg has been a science journalist for four decades. Link to full text in the New Yorkert: A pile of meaningless terms and poorly tested ideas.

Calibrating the ‘Hot-Spotting’ Hype | Medpage Today

Cancer Patients and Social Media. 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. Most programs in the demonstration focused on patients with chronic conditions who had been hospitalized within the previous year and assigned them to a care coordinator typically a registered nurse who assessed them and tje a plan of care.

You can listen to the interview apotters Its model utilizes “care teams” made up of health professionals with expertise in such disciplines as nursing, pharmacy, health coaching, counseling, social work, hawande community health work. 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.

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. According to a report published in the Journal of the American Medical Associationpatients assigned to the control group improved just about as much as those receiving the intensive services. 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.


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.

If Camden, New Jersey, becomes the first American community to lower its medical costs, it will have a murder to thank. It would be hard to say it better. Your email address will not be published. With this in mind, the dramatic results reported about programs like the Camden Coalition seem much less impressive. One that did was the Medicare Care Coordination demonstrationa program in which 15 healthcare organizations from around the country were given the opportunity to develop programs for improving care coordination among the most complex populations.

Nearly everyone involved anticipated success, and indeed enrolled patients experienced substantial improvements in health and reductions in hospitalization rates.

For example, a program could be piloted in one clinic and compared with a nearby similar control clinic. The paradigm — referred to as “hot-spotting” — has sprung up in dozens of places in the U.

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

A Vision of Connected Health: 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 coordinators also focused their efforts on hospital-to-home care transitions and medication management. 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 soptters assumed.

What do we have in complex care? The tenets of regression to the mean dictate spotter if a variable is extreme on its first measurement, it will, on its own, tend to be closer to the average on its second measurement.

This idea led to the creation of the Camden Coalition of Healthcare Providers. 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. Recent efforts by the Camden Coalition and other similar-minded innovators have inspired a much-needed renewed spotetrs on the most complex patients in our healthcare system.


Brenner’s program, the Camden Coalition agul, is widely considered the prototype for the country’s growing number of programs for high-need and high-cost populations. Fri, Jun 21st, Nobel peace prize winner Muhammad Yunus is no Links to all articles in the athl are available on the Gehr Center and Updates in Slow Medicine websites. As a result, many “super-users” gawandw hospital facilities today are likely to stop being high-volume users in the future, regardless of whether taul receive intensive targeted services — often referred to as “complex care management” — or ht.

After an initial intake visit, the team contacts enrolled patients at a minimum of twice monthly. 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.

He created a way to find the people whose use of medical care was highest, and go after them and provide better care. You may use these HTML tags and attributes: Leave a Reply Cancel reply Your email address will not be published. To rigorously assess their model, the Camden Coalition is now participating in a randomized trial of their program.

A neighborhood couple, spottwrs physical therapist and a volunteer firefighter, approached to see if they could help, but police waved them back. And he does it so well…. Brenner used data mining and statistical analysis to map health-care use and expenses. 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.

These kinds of cost savings are revolutionary. Gawande also describes a visit he made to the Atull Care Center, a clinic in Atlantic City, an experimental approach to primary care. This entry was posted in News. The controlled analysis of this program, unlike most of the others in the demonstration, showed not only reductions in avoidable emergency room and hospital visits but also reduced mortality among those enrolled. Keep Me Updated Signup to recieve latest updates and announcements.