Q4 2017 Newsletter - “Hotspotting” in Healthcare
By Thao Tran, Chair, Academic Alliance Community
Gawande’s (2011) highlight on Dr. Jeffrey Brenner’s hotspotting is a cost-effective, underutilized intervention in healthcare. Like many large systems, the American healthcare system is not designed to provide care for outliers. These outliers frequently visit ER and ICU for care. They are individuals with complex chronic conditions whose chronic condition worsen to the point where their conditions become too costly to manage [Camden Coalition of Healthcare Providers (CCHP), n. d.]. In hotspotting, data is used to locate the outliers, understand the problem, allocate resources, and create effective interventions for the outliers (CCHP, n. d.; Gawande, 2011). Hotspotting aligns with public health such that it fosters a “multi-disciplinary coordinated care that focuses on the whole patient and attends non-medical needs that affect health – housing, mental health, substance abuse, and emotional support” (CCHP, n. d., para. 3).
Although data mapping of hot spots might be a challenge for full implementation in the inmate population, a similar intervention could be used. Prison A is more than 60 miles from the nearest hospital. Usually when an inmate has a medical emergency, it takes 20 minutes for the ambulance to arrive at the prison, another 20 minutes to go through security, and then drive 45 minutes to the nearest hospital. An intervention that could be used is arranging for an ambulance to be near the prison. If a fight, trauma, or homicide occurs, valuable time would not be lost to have an ambulance near the prison to drive emergent cases to the hospital. If an inmate has hematuria, a government vehicle would be readily available to drive the inmate to the hospital. Having available transportation to care for acutely ill patients would save the federal prison system millions of dollars every year. A trip to the hospital in an ambulance could cost the government $3000 versus a trip to the hospital in a vehicle could cost $40. Sending every inmate in an ambulance is not economically feasible.
Camden Coalition of Healthcare Providers. (n. d.). Healthcare hotspotting. Retrieved from http://hotspotting.camdenhealth.org
Gawande, A. (2011, January 24). The hot spotters. The New Yorker. Retrieved from https://www.newyorker.com/magazine/2011/01/24/the-hot-spotters
Rosenthal, E. (2013, December 4). Think E.R. is expensive? Look at how much it costs to get here. The New York Times. Retrieved from http://www.nytimes.com/2013/12/05/health/think-the-er-was-expensive-look-at-the-ambulance-bill.html
WGBH Educational Foundation. (2011). Doctor Hotspot. Retrieved from http://www.pbs.org/wgbh/pages/frontline/doctor-hotspot/