Super Utilizer Case Management Program with Nursing Students

Abstract

Background: There are many patients who use the emergency department as it was intended. However, there are a small number of patients, or Super Utilizers, who make numerous visits to and incur high charges at the ED for issues that could be addressed elsewhere. In response to this situation, The Super Utilizer Program was launched. Modeling the care management program in Camden Coalition, the Super Utilizer Program is a joint effort between the continuum of care and Emergency Department (ED) at Stormont-Vail HealthCare (SVHC) and Baker University School of Nursing (BUSN). The goal of the program is to guide the Super Utilizer (SU) population in accessing resources, which would more appropriately address non-emergent health care issues.

Purpose: The purpose of this study is to evaluate the effectiveness of a Super Utilizer Program which uses baccalaureate nursing students as health care coaches. A secondary purpose is to discover and understand the underlying issue(s) for high ED use.

Study Design: This is a quantitative, observational retrospective study.

Methods: IRB approval for this study has been obtained. We will examine the number of emergency department visits, client access to and utilization of primary care and/or insurance, and connection with community resources (food, shelter, transportation, childcare, mental health, dental, disease management, medical assistance programs/pharmacy, workforce, health home/case management, rent or utility assistance, clothing assistance, and other services). To accomplish this task, we will conduct a retrospective chart review of all enrollee records enrolled in the program during the Fall 2013 and Spring 2014 semesters. Data will be collected from the six months prior to and six months after enrollment into the Super Utilizer case management program. Data collection will involve a manual chart review of SVHC records to obtain baseline and post enrollment data including chief complaints, number of ED visits at SVHC and surrounding facilities, number of student to client encounters, number of community services in use, other comorbidities, connection with a primary care provider, insurance coverage, medical and mental health referrals, hospital admissions, and client demographics. A form for data collection will be tested for inter-rater reliability with three case studies prior to the start of data collection.

Findings: Results will be collected and finalized by May 1, 2015.

Conclusion: The study has not been completed yet, however, we believe that the Super Utilizer Program using baccalaureate nursing students as health care coaches will show a decrease in the amount of inappropriate ED usage, an increased connection to primary care, and community resource referrals.

Clinical Relevance: This study will present evidence about the efficacy of an innovative way to assist Super Utilizers find appropriate care. In addition, this study will help the emergency department understand the main reasons for these high frequency visits.