A holistic client-centred program for vulnerable frequent hospital attenders: cost efficiencies and changed practices.
OBJECTIVE
A small percentage of Australians frequently attend hospital emergency departments (ED) with potentially avoidable health crises. These individuals are termed 'vulnerable' due to their complex health and social needs. When these needs are unmanaged, unnecessary ED and hospital-admission costs are incurred. A holistic community-based program was developed to engage a cohort of vulnerable individuals in strategies to improve their health and health behaviours, and health service use.


METHODS
A purposive sample of frequent ED attendees was identified in one Australian metropolitan health region. Core program elements included working with clients within their environment, problem solving, empowerment, education, goal setting and mentoring. Evaluation data included services provided for, and time spent with, clients; hospital admission and emergency department attendances and related costs; client engagement data; mental health measures; client stories and participant interviews.


RESULTS
Data was analysed from 37 clients. On average, staff spent 34 hours with each client, costing approximately $1,700 each. Significant improvements resulted in client health and health behaviours. Crisis emergency department and inpatient admissions decreased, and planned outpatient clinic use increased.


CONCLUSIONS
Low-cost community-based intervention for frequent ED attendees has the potential for significant tertiary hospital savings.
International Centre for Allied Health Evidence, Division of Health Sciences, University of South Australia, Adelaide. Karen.grimmer-somers@unisa.edu.au
Karen
K
Grimmer-Somers
Kylie
K
Johnston
Elizabeth
E
Somers
Julie
J
Luker
Luzi Ann
LA
Alemao
Dianne
D
Jones
D000328:Adult; D000368:Aged; D001315:Australia; D003153:Community Health Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006300:Health Services Misuse; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000191:economics*; D016730:Program Development; D017678:Sex Distribution; D035862:Vulnerable Populations / Q000523:psychology