142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Eliminating a Camden City Hotspot - Lessons Learned about the Importance of Segmentation

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Nadia Ali , Camden Coalition of Healthcare Providers, Camden, NJ
Victoria DeFiglio, RN , Camden Coalition of Healthcare Providers
Uchenna Emeche, MD , Camden Coalition for Healthcare Providers, Camden, NJ
Wendell Kellum, MD
Background:  The 2011 New Yorker article “The Hot Spotters” brought national attention to the work of Dr. Jeffrey Brenner using hospital data to study geographic clustering of disproportionate healthcare utilization in Camden, NJ.  Northgate II, a 23-story high rise for the elderly and disabled was one of the identified hotspots. 

Methods: Multiple interventions have been attempted at Northgate II to improve care and reduce preventable hospital utilization.  Wellness programs such as diabetes classes, exercise classes and art therapy were conducted in the building.  Foremost among the early interventions was the establishment of a primary care practice in the building.

Results:  A secondary analysis of medical utilization from Northgate II revealed a “hotspot within the hotspot.”  Of the approximately 332 residents, only 20 (6%) were frequently admitted to the hospital.  These 20 patients accounted for 61% of the hospital-based medical costs for the building.  The qualitative evaluation of early wellness programs suggests that these programs were attended mostly by well patients – not the patients accounting for the majority of spending.  Analysis of the patient panel of the on-site PCP office revealed that only 7 of the 20 highest utilizing patients (35%) came to that practice for care. 

Conclusion:  The experience gained from the initial interventions highlights the importance of segmentation, “the hotspot within the hotspot,” when working to improve care in geographically clustered areas of high utilization.  At Northgate II, our intervention’s success in improving care and reducing cost will depend greatly on our ability to engage the highest utilizing patients within the building.  Strategic planning and structured evaluation of our progress needs to proceed with great attention to this segment.  The Camden Coalition is currently partnering with the Social Services Department at Northgate II to coordinate a home-based care management model to serve all Northgate II residents who become hospitalized.

Learning Areas:

Planning of health education strategies, interventions, and programs
Program planning
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Define "hotspotting" and explain its relevance as it relates to patients and communities who are statistical outliers in terms of medical utilization and cost. Discuss the importance of segmentation when designing and evaluating interventions to improve care and reduce cost for high-utilizing patients.

Keyword(s): Information Technology, Community-Based Partnership & Collaboration

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the co-lead for the project that is being described in the abstract. Among my interests has been the development of strategies to enhance the use of primary care for preventing hospitalizations specifically for the elderly population.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.