title: The highest utilizers of care: individualized care plans to coordinate care, improve healthcare service utilization, and reduce costs at an academic tertiary care center.
abstract: BACKGROUND
  High utilizers are medically and psychosocially complex, have high rates of emergency department (ED) visits and hospital admissions, and contribute to rising healthcare costs.
  
  
  OBJECTIVE
  Develop individualized care plans to reduce unnecessary healthcare service utilization and hospital costs for complex, high utilizers of inpatient and ED care.
  
  
  METHODS
  Quality-improvement intervention with a retrospective pre/post intervention analysis.
  
  
  METHODS
  Nine hundred twenty-four-bed tertiary academic medical center.
  
  
  METHODS
  Twenty-four medically and psychosocially complex patients with the highest rates of inpatient admissions and ED visits from August 1, 2012 to August 31, 2013.
  
  
  METHODS
  A multidisciplinary team developed individualized care plans integrated into our electronic medical record (EMR) that summarize patient histories, utilization patterns, and management strategies.
  
  
  METHODS
  Primary outcomes included inpatient admissions, ED visits, and corresponding variable direct costs 6 and 12 months after care-plan implementation. Secondary outcomes include inpatient length of stay (LOS) and 30-day readmissions.
  
  
  RESULTS
  Hospital admissions decreased by 56% (P < 0.001) and 50.5% (P = 0.003), 6 and 12 months after care-plan implementation. Thirty-day readmissions decreased by 66% (P < 0.001) and 51.5% (P = 0.002), 6 and 12 months after care-plan implementation. ED visits, ED costs, and inpatient LOS did not significantly change. Inpatient variable direct costs were reduced by 47.7% (P = 0.001) and 35.8% (P = 0.052), 6 and 12 months after care-plan implementation.
  
  
  CONCLUSIONS
  Individualized care plans developed by a multidisciplinary team and integrated with the existing healthcare workforce and EMR reduce hospital admissions, 30-day readmissions, and hospital costs for complex, high-utilizing patients.
authors: Internal Medicine & Pediatrics Residency Program, Duke University Medical Center, Durham, North Carolina.
authors: Tim
authors: T
authors: Mercer
authors: Division of Hospital Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors: Jon
authors: J
authors: Bae
authors: Division of Hospital Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors: Joanna
authors: J
authors: Kipnes
authors: Duke Performance Services, Duke University Medical Center, Durham, North Carolina.
authors: Maureen
authors: M
authors: Velazquez
authors: Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina.
authors: Samantha
authors: S
authors: Thomas
authors: Division of Hospital Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors: Noppon
authors: N
authors: Setji
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010347:Patient Care Planning / Q000458:organization & administration*; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000191:economics*; D014481:United States