New research in the USA has exposed the lack of evidence that; costly and complex data-led attempts to target the small number of patients with complex medical and social needs (so-called “super-utilisers”), can either reduce demand or cut costs.

A study in the New England Journal of Medicine revealed that the “Camden model” (using a multidisciplinary team of clinicians, social workers, community health workers, and health coaches to work with patients in the hospital and then at home, with a primary goal of helping patients stay out of the hospital) had no impact on hospitalizations or associated costs in a 6-month follow-up period:

Summarising the latest findings in the Millbank Quarterly, Paula Lantz, who has analysed dozens of similar reports argues that while these “much-anticipated findings” have been described in the press and on social media as “surprising,” “shocking,” and “disappointing,”

“The unfortunate reality is that these evaluation results are not surprising at all. Red flags regarding the hype and overpromise of super-utilizer interventions have been waving for several years. 

“The majority of super-utilizers live in communities facing multiple socio-economic challenges. They also have been exposed to decades of constrained opportunities, social/environmental risks, and chronic psychosocial stress, much of which stems from institutionalized discrimination and structural deprivation. We should not be surprised that the social determinants of health create high-need/high-cost patients who do not experience sudden improvements 6-12 months after a case management intervention. …

“The truth is that hot-spotting interventions are primarily cost-containment strategies aimed at individual, very expensive patients. They are not interventions aimed at the macro- and community-level systems and institutions that drive social, political, and economic disadvantage and health inequities.”

Similar findings in England don’t appear to have deflected NHS England from investing in their own “frequent flier” approach.

A National Audit Office review of the approach on reducing emergency admissions said it was difficult to settle on an effective method given the paucity of data on readmissions. They also suggest that bed closures have increased the pressures – from 2010-11 to 2016-17, the average number of available general and acute beds has fallen by 6,268 beds (5.8%)

 

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