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Part 1: Hotspotting in the UCSD Student-Run Free Clinic: identifying patients for enrollment in Complex Care Service case management ; Part 2: Hotspotting applied: creating a model for the provision of case managed care for complex patients identified at the Student-Run Free Clinic Project

Abstract

Part 1: The University of California, San Diego (UCSD) Student-Run Free Clinic Project (SRFCP) serves a subset of complex patients who may benefit from additional levels of care coordination and support beyond the scope of what is currently provided in the clinic. The Complex Care Service (CCS) created a patient-centered care delivery system featuring medical students as case managers to address the needs of this population. A student-run elective (FPM 275) that developed from the CCS is seekign to enroll complex patients that would benefit from coordinated case managed care. Complex patients must first be identified. This project examines current practices of patient identification through 'hotspotting', finding that most selection is through subjective physican referrals or objective emergency medical services (EMS) utilization data. It then uses these heuristics as a guide to systematically rank free clinic patients by complexity and healthcare utilization, finding that SRFCP patients utilize EMS appropriately and that patients at risk for primary care breakdown are those with a greater degree of complexity. Finally, it uses these findings along with SRFCP physicians' subjective referrals to generate a list of patients and to develop an appropriate model for future patient enrollment in case managed care through FPM 275 at the SRFCP. Part 2: The University of California, San Diego (UCSD) Student-Run Free Clinic Project (SRFCP) serves a subset of patients who face the burden of multimorbid chronic disease, limited health literacy, and psychosocial barriers to health. Complex patients typically require high levels of healthcare resources and may benefit from additional levels of care coordination and support beyond the scope of what is currently provided at the SRFCP. The Complex Care Service (CCS) was created to address the needs of this population through a patient-centered care delivery system featuring medical students as case-managers. The primary goals of this service were two-fold: to improve outcomes for complex patients by developing their health literacy, self-management skills, and health related self-efficacy; and to develop medical students' ability to facilitate health behavior change and to provide collaborative case managed care to SRFCP patients. This project documents the creation of the CCS and its transformation into a student-run elective with the expansion of the service, the development and refinement of clinical tools, and the formalization of medical student training in motivational interviewing and health behavior change as a means to sustainably continue case managed care for complex patients identified at the SRFCP.

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