Identifying Hospital Care High Utilizers

In the coming years, VHHA’s Center for Healthcare Excellence will expand its works with members on addressing high utilizers of hospital care. High utilizers are patients who have four or more hospital admissions within a 12-month period. These patients are frequently younger than 65 and have multiple chronic diseases, such as diabetes and hypertension, that can be managed in ambulatory settings. High utilizers move to Medicare insurance coverage as they age. Without intervention, high utilizers are likely to become more infirmed. As that happens, their admissions tend to increase as their chronic conditions go untreated, or undertreated, outside of the hospital setting. Another consequence is that these patients’ quality of life also diminishes. Identifying these patients early enables hospitals and health systems to offer customized care options. Patients and hospitals can benefit from the provision of more effective, coordinated care, which can lead to reduced need for frequent hospital care. Addressing this issue requires determining the scope of the problem. To do that, VHHA’s data and research team used the hospital-wide readmissions database to search for high utilizers. The database captures the largest group of patients with the most common admissions diagnoses. We quickly confronted the same paradox hospitals encounter when trying to resolve frequent hospitalizations among a small group of patients. Assessing the number of high utilizers by hospitals revealed that 15,622 people accounted for 51,537 admissions – roughly 13 percent of all Virginia admissions. Relying solely on state data to assess this population turns up fewer patients (10,608). Further data exploration revealed another variable: patients admitted to multiple hospitals by different physicians. The data show 5,014 high utilizer admissions which occurred in more than one hospital. Said another way, the data reveal that for every two hospitalizations by a high utilizer in the same hospital, that patient had another admission in a separate hospital. As with many other quality issues, mitigating the challenges presented by high utilization necessitates collaboration between providers in the ambulatory and inpatient settings that may be part of different health care systems. (5/20)

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