Incorporating Teamwork Strategies for Internal Medicine Residents in Training to Mitigate Hospital Utilization for High-Risk Patients.

Complex, high-risk patients experience poor health outcomes, and many utilize the emergency room for routine primary care in lieu of outpatient visits. In 2017, we created the Comprehensive Care Clinic (C3) at Brown University Health, Providence, Rhode Island to identify and address the factors responsible for excess emergency room and hospital utilization for patients identified as high utilizers. This study evaluated the outcomes of a group of 159 patients who participated in C3 during the time period of 2017-2019. Emergency Department (ED) and Inpatient (IP) utilization is measured before and after the index C3 visit and compared with our control group of similar patients who did not participate in the C3 visit. Assistance with point-of-care issues such as transportation, medications, and addressing health literacy and the provision of targeted health coaching are the major interventions. A reduction of 56% for combined ED and IP utilization was measured for a group of 159 patients compared with our control group. A team-based approach to the care of high-risk patients in a residency ambulatory clinic allows for targeted interventions that resulted in reduced ED use and IP admissions. Internal Medicine resident physicians also learn the benefits of team-based care.