A program at San Francisco General Hospital Medical Center designed to reduce the number of emergency department visits by "high-user" patients has received a top award from the California Association of Public Hospitals and Health Systems (CAPH).
The award was presented yesterday during the CAPH two-day annual conference (December 2-4) that is taking place in San Francisco.
The CAPH "management excellence award" honors the Emergency Department Case Management Program at SFGHMC. Now three years old, the program has shown early success in reducing the number of emergency visits, saving costs, and supporting patients through social services.
The program is directed by Robert Okin, MD, chief of psychiatric services at SFGHMC and UCSF professor of psychiatry, and Alicia Boccellari, PhD, director of SFGHMC psycho-social medicine and UCSF associate professor of psychology. Kathy O'Brien, LCSW, is program coordinator, and James Oh, MD, is medical director. In presenting the award CAPH officials noted that the approach is a "winning strategy from both a quality of services and financial viewpoint."
The program set out to solve the problem of emergency department (ED) high-users against difficult odds, according to Okin. Some of these individuals visit the hospital ED as many as 50 times a year, and a majority have overwhelming medical and social needs, including homelessness, unemployment, lack of medical, insurance, histories of substance abuse and psychiatric problems, and varying degrees of brain damage.
The focus of the SFGHMC program is intensive one-on-one management of each individual in the ED high-user group. Case managers work to establish a personal relationship, providing assistance with appointments, entitlement paperwork for housing and financial aid, medical care, substance and mental health treatment, and other support services, provided both in the hospital and in the community.
Preliminary analysis of 45 patients in the program show reductions in five key areas: ED visits decreased by 21 percent, hospitalizations by 30 percent, homelessness by 44 percent, substance abuse by 38 percent, and cost to the health delivery system by 55 percent.
SFGHMC is affiliated with UC San Francisco and is part of the Community Health Network of San Francisco, the City's integrated care delivery system that also includes Laguna Honda Hospital and Rehabilitation Center, 18 community health centers, and home health and jail health services.