Using Data to Drive Care Coordination Of Frequent Users Of Medical Transports and Emergency Departments
In August 2014, Mecklenburg EMS Agency (Medic) and Mecklenburg County Community Support Services developed a framework to identify individuals with high frequency use of emergency transports in order to access medical care. Utilizing Medic to access non-emergency medical treatment is costly, an inappropriate use of resources, and ineffective in addressing the needs of these patients.
The framework uses a two-pronged approach to identify patients with high Emergency Medical Service use, looking at frequency and consistency. A system user is identified when their frequency of transport over the previous consecutive four months is greater than or equal to one transport per month, and has been transported at least one time per month in the preceding two-month period. This allows the group to evaluate the strain on the system and ensure that intervention efforts are focused on patients with recent needs.
Although many of the “frequent users” identified suffer from chronic physical health and mental health conditions, care coordination across systems has strengthened connections to appropriate resources and decreased transports.
This work has been impactful for patients and the community. Determining key stakeholders across private and public systems in addressing the acute or chronic needs of these individuals and assisting in care coordination has been critical to engage people with varying needs. It has also provided opportunities to better understand gaps across systems and to determine strategies to address them. Data is used to drive decision-making and focuses the attention on those with the most complex needs.
This work is part of a collaborative that consists of representatives from the hospital, healthcare groups, homeless service providers, substance use and mental health treatment providers, and other public systems. The group meets monthly to discuss the current 25 most frequent users of emergency medical transports.
Each month, the group considers interactions the patients have had with systems of care, including barriers to resources, and develops an action plan. Case managers or social workers working with patients attend these meetings and then go back to the patients to work with them to help address unmet needs. The strategies of Harm Reduction and Motivational Interviewing are used when engaging patients.
Harm Reduction incorporates a spectrum of strategies from safer use, to managed use to abstinence to meet substance users “where they’re at,” addressing conditions of use along with the use itself. It is aimed at aimed at reducing the negative consequences associated with the use of substances. Motivational Interviewing is a “collaborative, person-centered form of guiding to elicit and strengthen motivation for change.” It focuses on exploring and resolving ambivalence and centers on motivational processes within the individual that facilitate change.
A common gap for all patients has been the lack of social and emotional supports while uninsured patients have the additional stress of limited access to resources.
There has been more than a 40% reduction in transports for the first 15 patients identified. It takes approximately eight months of care coordination in this manner for a sustained change, or reduction in transports.
Although homelessness is not something that impacts all high use patients, housing with supportive services has been the key intervention for individuals who are homeless in reducing their non-emergency transports.
Karen Pelletier is the Business Manager for Mecklenburg County Community Support Services. She is responsible for the day to day operations of the department as well as leading a variety of community initiatives that positively impact vulnerable populations.