3-step framework helps healthcare systems identify high-need, high-cost patients
Researchers from the RTI-University of North Carolina (UNC) Evidence-based Practice Center, Research Triangle Park, NC developed a 3-step process to help healthcare systems identify high-need, high-cost (HNHC) patients. Identifying these patients at early stages can help control hospital and clinic costs. The full review and framework are published in Annals of Internal Medicine.
Starting from a National Academy of Medicine (NAM) taxonomy, researchers used a “best fit” framework synthesis approach to examine characteristics and criteria to identify HNHC adult patients, defined as those with high use (emergency department, inpatient, or total services) or high cost. Based on their review of 64 studies published in 65 articles, the researchers created a 3-step process for identifying such patients in the healthcare setting: 1) identify clinical or functional risks; 2) assess for behavior or social risk factors; and 3) identify patterns of healthcare usage. Patients with multiple comorbidities or chronic clinical conditions, such as heart disease, chronic kidney disease, diabetes, chronic lung disease, cancer, hypertension, and chronic pain were more likely to be HNHC users. Also, having mental illness or substance use disorders or facing poverty, homelessness, or food insecurity increased the risk of being HNHC healthcare users. Finally, those with a pattern of high healthcare use in the past were more likely to continue this pattern. According to the researchers, this framework could be a good place to start to help improve quality and efficiency of care in hospitals and clinics.
