In David Tuller’s article, “A New Way to Support Frequent Emergency Department Visitors,” he discusses the multivisit patient (MVP) program launched by Harris Health Systems to address the issue of frequent emergency department (ED) visits. A small percentage of patients regularly account for a large number of visits, causing overcrowding and dissatisfaction with the care received. These patients are often heavy users of other healthcare resources, have chronic conditions and are more likely to be affected by social determinants of health such as substance use disorder, mental health issues, and homelessness. The MVP program aims to build a relationship with these patients and help transition them to the outpatient setting for treatment. The program has seen a 15% reduction in visits by MVPs and has coordinated with other local hospitals and organizations to maximize its reach and address the patients’ non-medical needs. By opening this gateway into a larger system, the MVP program can catch a new population that was missed through the social service sector and adequately address their needs, reducing barriers to proper healthcare (Tuller, 2022).
As a clinical research coordinator, I have noticed several of our patients utilizing the emergency department for non-urgent reasons. For example, I was speaking with a patient who has moderate to severe asthma. As I asked about his medication refills and assessed how well controlled his asthma is, he explained to me that he would go to the emergency room every time he ran out of his albuterol inhaler. I was surprised to hear this and asked if he had a primary care provider, which he did not. He previously had a primary care provider but did not like waiting for an appointment or the way they were addressing his problems, so his simple “solution” was to utilize the emergency department. I could tell that he was very familiar with the ED and how to get what he thought he needed, quickly. I could also tell that his asthma is very poorly controlled, but because he had been dealing with it for 30+ years, he learned to “tough it out,” even when he was clearly not okay.
Tuller supports the idea that by flagging and identifying patients who frequently visit the ED, there can be a better understanding for why these patients are there. By doing so, the root problems can be addressed. This approach helps meet the needs of patients, while also preventing many future visits to the ED. Not only does this improve patients’ wellbeing but it also reduces the burden on the ED and healthcare costs. Tuller includes examples and interviews of individuals in the area who have been impacted by the MVP program or have been involved in its development. I think it would have been beneficial for Tuller to discuss potential negative impacts the MVP program may have.
Recognizing and addressing social determinants of health is an important aspect of improving health care delivery. I noticed through my daily work in clinical research that numerous patients are facing barriers to accessing proper health care and other essential needs. I conduct many follow-up phone calls for patients throughout their study period to see how they are doing. Many patients are low income, some unhoused, and rely on the compensation from the study to pay for basic needs. Many of these patients lack reliable transportation, which is one barrier to attending their visits. Thankfully, when these issues are identified, we can do our best to address them. In this case, providing the patient with an Uber ride to and from their appointment helped. Because many studies require bloodwork and various procedures, I think participation in clinical trials is a great way for people who are uninsured or low income to access medical care they might not get otherwise.
Seeing the MVP program be implemented through Harris Health Systems shows promising results. I think that if other states could implement programs like this, health care costs could be reduced substantially. This could also help provide funding for expansion of Medicare and Medicaid programs and reduce the number of uninsured people in our country. I enjoyed reading this article and learning about how the MVP program deals with these types of patients. I was glad to see that the program is addressing social determinants of health and not just strategies to stop the same patients from coming into the ER.
Tuller, D. (2022). A new way to support frequent emergency department visitors. Health Affairs, 41(7), 934–938. https://doi.org/10.1377/hlthaff.2022.00680
Hello Maddy,
I think the MPV program is a great idea to help the burden that is on the health care system. I have met a lot of people that when something happens health wise to them, they go straight to the emergency room for help even though it may not be a true emergency. At WIC we met parents that took their child to the emergency room when they had just a simple cold. A lot of WIC participate have pediatricians for their children but still take their child to the emergency room when something pops up rather than going to their primary doctor. It may be like you said that they don’t want to wait to see their primary doctor or know how to use the emergency room to get what they want. I think that by helping people find other ways to get their care before rushing to an emergency room would benefit the person and the health provider. The person would get proper care and have their symptoms better addressed by those outside of the emergency room such as your story with the mismanagement of asthma due to patient not getting treatment by an outpatient setting. It would also limit the burden on the emergency room and get to people that are having a true health emergency quicker. There could be barriers depending on the area such as if there are good resources to send people to such as rural area where health care facilities may be spread out over distances that are not easy cover.