The IFFCOSM

1
The IFFCOSM

• Lance Cartlidge, Shane Desselle
• Lauren Hayes, Gena Massey
• SuAn Phipps, Susan Reed
• Shelly Wells

2
IFFCOSM

• Interdisciplinary Frequent Flyer Clinic for
  better Outcomes to Save Money

3
Problem

• Lack of access to outpatient and/or
  post-discharge assessment (need for medications,
  counseling, health education and lifestyle
  considerations) leads to frequent hospital
  readmissions.
• Frequent Flyers

4
The Need

• Tulsa area hospitals in 2002
• Provided twice as much uncompensated care as
  other Oklahoma hospitals, when adjusted for
  staffed beds
• Endured an actual loss of 56 million (Lewin
  Report, 2006).
• OSU identified 100 patients with an uncompensated
  cost of 5 million last year. One patient cost
  1 million (Clancy, 2009).
• St. Francis Health System CFO expects veritable
  tsunami of uninsured, frequent flyer patients in
  the coming 12 months (Summer Institute, 2009).

5
Frequent Flyers

• Two or more hospital admissions over the past two
  years

6
Goals

• Decrease the number of Frequent Flyer
  admissions to the hospital through timely
  interdisciplinary case management
• Reduce health care expenditures
• Improve quality of life for those underserved in
  health care

7
Team Players

• Medicine
• Nurses
• Pharmacists
• Social Workers
• Behavioral/Mental Health Workers

8
Interdisciplinary Case Management Model
Intake Coordinator
Interdisciplinary Team
OU School of Community Medicine Medical Home
Team Home Intervention
Community Agency Network Referrals
9
Business Plan

• Contract with an area hospital to use the
  Interdisciplinary Case Management Team to reduce
  the number of Frequent Flyer admissions.
• Contracting hospital will refer patients and pay
  a per capita fee.
• Start-up with one hospital and small group of 20
  to 30 patients.

10
Program Evaluation

• Hospital admissions averted
• Emergency department admissions averted
• Appropriate intermediate clinical outcomes
• Patient satisfaction and health-related quality
  of life
• Financial solvency and sustainability

11
An Example

• MP is a 56 year-old female with congestive heart
  failure. In the past 2 years she has been
  admitted to the hospital 7 times complaining of
  shortness of breath.

12
Research and Education

• Case management will be evidence-based.
• Educational interventions will be unique and
  applied from well-established models.
• Transtheoretical Model of Change
• Health Belief Model
• Self-efficacy Theory
• Locus of control Theory
• Anderson Adays Model of Health Care
  Utilization
• The environment provides rich, myriad
  opportunities for research and the attraction of
  extramural funding.
• The model employed provides an excellent
  framework for interdisciplinary education.

13
SERVICE
IFFCOSM
EDUCATION
RESEARCH