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Emergency Department Super Utilization

Nathalie Ashby, Kenneth Lam, Salar Sanati

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OUR TEAM

Salar Sanati

Biochemistry

Kenneth Lam

Biochemistry

Nathalie Ashby

Kinesiology

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Who are “Super Utilizers”?

Complex physical, behavioral, and social needs
Typically lack a medical “home”
Lack effective, coordinated care
Have high healthcare costs from avoidable utilization of inpatient care and emergency department services

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Causes of Super Utilization⁹

Multiple Chronic Diseases
English not primary language
Transportation
Poverty
Fragmented care
Food insecurity
Lack of access to primary care

https://www.regionalonehealth.org/blog/2018/07/03/one-health/

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Emergency Department (ED) Over Utilization: costly, inefficient, and ineffective

Only 1% of the population accounts for nearly 22% of annual healthcare expenditure.³
Most conditions treated in emergency department can be treated or prevented by regular primary care.⁴
Emergency departments are not equipped to properly address the complex issues presented in super utilizers.

https://www.hcup-us.ahrq.gov/reports/statbriefs/sb221-Super-Utilizer-ED-Visits-Payer-2014.jsp?utm_source=ahrq&utm_medium=en-1&utm_term=&utm_content=1&utm_campaign=ahrq_en3_7_2017

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Urbanization in Houston

Texas ranks among the worst states in the ratio of primary care provider per patient.⁸
This shortage is expected to get worse over the next 12 years as Houston’s population grows.⁸

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Correlation Between Low Household Income and Primary Care Access

https://hhs2010.sph.uth.tmc.edu/SingleMapReport/

LBJ Hospital

Ben Taub Hospital

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Super Utilization in Houston: Harris Health System

Harris Health System hospitals serve a large population of disadvantaged patients.

54% uninsured, 33.8% rely on government benefits.⁵
53.6% Hispanic, 25.3% African American.⁵

https://www.hospitalstats.org/ER-Wait-Time/Houston-TX-Metro.htm

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How can telemedicine help reduce emergency room super-utilization in Harris Health system hospitals and increase primary care accessibility for low-income populations of Houston?

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How Does This Relate to Emergency Room Super-Utilization?

The emergency room is not the best place to receive primary care
Super-utilizers only make up 5% of emergency room patients however they account for 50% of spending

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What Are Our Objectives?

Apply telemedicine towards increasing primary care accessibility
Combat emergency room super-utilizer recidivism with personalised care and treatment plans
Lower expenditures of both super-utilizers and emergency departments

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Research Plan

LBJ and Ben Taub Trials (100 members) 1 year monitoring
Pair with primary care physician through telehealth with no cost to patient
Electronics provided for those in need

Treatment and monitoring based on “Camden Coalition Accountable Care Organization Gainsharing Plan”

Measure recidivism and health improvements

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Long-Term Opportunity

Helping both patient access and hospital finances

Personal Care Plans have shown effective in decreasing ED recidivism (Bergenstal et al.)

Harris Health Funded Program

Increase accessibility to Primary Care for many low-income communities through telehealth
Increase job opportunities for primary care physicians
Futureproof (natural disasters, pandemics, etc.)

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Thank You

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Resources