The Impact of Interprofessional Student Hotspotting on Student Participants

Across the nation, individuals with complex medical and social needs frequently use emergency rooms and hospitals, often as a result of social determinants of health. Coined “super-utilizers,” 5% of patients account for 50% of national healthcare expenditures. Despite high utilization, these patients “fall through the cracks” of a fragmented healthcare system resulting in poor outcomes (Long et al., 2017). On average, super-utilizers are publicly insured, have fair to poor health and suffer from multiple chronic conditions, including behavioral health issues and substance abuse disorders (Bronsky et al., 2017). This population is disproportionately impacted by social determinants of health, including food and housing insecurity, and often have complicated relationships with the healthcare system, reporting negative perceptions of care received (Bronsky et al., 2017).

As the national dialogue on the importance of addressing social determinants of health builds momentum, the necessity to address the needs of complex, vulnerable patients emerge as a top priority in healthcare delivery and education (Daniel, Bornstein, & Kane, 2018). Academic Health Centers (AHCs) have a responsibility to create high-performing health systems that address the gaps in care and to educate practice teams to provide a new level of care that extends beyond traditional norms (Blumenthal, McCarthy, & Shah, 2018; Daniel et al., 2018).

In 2017, AHCs were issued a “call to action” to prepare a new generation of providers equipped to address this crisis in complex care (DeVoe, Likumahuwa-Ackman, Shannon, & Steiner Hayward, 2017). Existing curricular models of complex care have not been developed or implemented at AHCs or sufficiently tested with students on the care teams as value-added practitioners. While promising clinical pilots in caring for patients with complex needs are emerging, these models lack an educational focus to adequately prepare the future workforce (IOM, 2017). There are several powerful examples of how clinical teams are effectively doing this work in practice (Long et al., 2017). Hotspotting, one such example, is a program that trains interdisciplinary teams of professional students to learn to work with complex medical and social needs using a patient-centered approach. The six-month program provides education and support to teams as they connect with patients, learn about the root causes of high healthcare utilization and share the learning experience with their institutions. To date, there remains a gap in transferring the knowledge and skills acquired by real world complex care teams into our current medical and health professions education programs. Additionally, there is little data on the impact of student hotspotting on student knowledge, skills, and attitudes as the current published data from the hotspotting program has primarily focused on program evaluation (Bedoya et al., 2018).

The purpose of this pilot study was to explore the impact of an advanced interprofessional education experience, the Interprofessional Student Hotspotting Learning Collaborative (ISHLC), on student participants. The learning objectives of the ISHLC were to: improve understanding of how to build authentic healing relationships with complex patients, gain the ability to empathetically conduct community visits, improve the ability to work on an interprofessional team, gain experiential learning of system complexity, improve understanding of patient barriers to care, and deepened knowledge of system motivators.

The first cohort of eight XXX hub-based ISHLC teams participated from September 2017 through March 2018. In total, after a competitive internal application process, 45 XXX students from 7 professions, including medicine, nursing, occupational therapy, pharmacy, physician assistant, public health and social work were enrolled, placed into five or six-person teams, and completed the ISHLC curriculum. Our operant hypothesis was that student team members who participated in the seven-month intervention would increase their knowledge of, comfort working with and empathy toward medically and socially complex patients. We used a pre-/post-survey design to explore the impact of the program on the student participants, including changes in knowledge, skills, and attitudes (KSA) and empathy were measured. A KSA survey was adapted from the Attitudes Toward Homelessness Inventory (ATHI) and the Health Professionals’ Attitudes Toward Homelessness Inventory (HPATHI) (Buck et al., 2005) and informed by Asgary et. al.’s 2016 work. Students also completed the XXX Scale of Empathy for Health Professions (XSE-HPs) a validated survey designed to assess clinician empathy across a variety of concerns (Fields, et. al, 2011).

Preliminary quantitative results using hierarchical modeling showed interactions between group membership and pre-post scores such that the participant group (n= 42) did not decline in self-efficacy or empathy compared to the control group (n = 15). Knowledge, confidence, and interest started high and remained high in both groups. Preliminary results indicate that students who participated in this student hotspotting program developed increased self-efficacy in caring for patients with complex medical and social needs, along with an enhanced understanding of other health professionals’ roles and a sense of feeling more adequately prepared for future collaborative practice.

The ISHLC offers a value-added IPE curriculum that transfers the knowledge, skills, attitudes and behaviors needed to work with patients with complex medical and social needs to our students. As rising members of the next generation of care teams, we hope to graduate students who are equipped with the skills needed to work with this population. The significant interactions between groups and pre-post for efficacy and empathy suggest that the changes in student hotspotters’ scores were not due simply to maturation, but rather the result of their participation in the ISHLC. Thus, our pilot implies that the ISHLC is a mechanism to prepare students to provide complex care. Next steps include a multi-site study incorporating a larger cohort of students from across national student hotspotting hub sites to determine the impact of this program on student teams and hotspotting patients.