Social and economic hardships explain why some patients return to the hospital time and again, a team of University of Washington students found in a six-month project.

“Healthcare providers need to be aware of the chaos in some patients’ lives,” said Eliza Hutchinson, a fourth-year medical student who organized the team – one of 10 across the country participating in the Student Hot Spotter Minigrant Project.

The terms “hot spotter” and “super-utilizer” relate to the disproportionately high use of medical services by a small percentage of the general population. UW students got to know four super-utilizers, talking with them in the hospital and at their homes after they were discharged, and focusing on patients’ stories.

Sheridan Reiger, MPH, is a fourth-year medical student, and his group followed a man in his sixties with chronic pain and severe respiratory disease. “He lived in [Seattle’s] Central District, where he had grown up, but he wasn’t really in touch with his family. He didn’t have a partner. Through his life he had managed to push quite a few people away. He was pretty isolated,” Reiger says.

Another patient, a young woman in her thirties with lupus, “was a near-perfect patient,” Hutchinson says. She had a good relationship with her physician, took her medication and came to follow-up appointments. But her medical bills had bankrupted her family. It also became clear that she didn’t understand English as well as her team originally thought. To remedy the language barrier, they engaged a cultural navigator to interpret during clinic visits and to culturally tailor nutritional instructions.

Home visits were crucial to understanding patients’ day-to-day challenges. “You saw how they lived, the physical challenges they faced,” says Hutchinson. “And the patients were often more comfortable talking to us in their homes than they were in hospital rooms.”

Alexandra Molnar, M.D. ’01, an attending physician at Harborview Medical Center’s International Medicine Clinic, was the project’s faculty sponsor and noted that it helped students think broadly about issues — like transportation and nutrition — facing patients.

Sheridan Reiger agrees. “If we have a patient in the hospital and ready for discharge, we need to constantly ask ourselves: what is it that will bring them back?” he asks. Then it’s a matter of using the system — community health workers, follow-up nursing calls and other methods — to keep them healthy and at home.

Eliza Hutchinson, a fourth-year medical student (right), and Kelsey Rasmussen, a doctoral candidate in pharmacy, discuss a patient at Harborview Medical Center. They’re both part of the Student Hot Spotter Minigrant Project, sponsored by the Association of American Medical Colleges, Primary Care Progress and the Camden Coalition.

Hot Spotters and Super-utilizers
The term “hot spotter” comes from Jeffrey Brenner, M.D., a family physician in Camden, N.J., who used statistics from hospitals and ambulance services to identify the city’s “hot spots” — areas from which a disproportionate number of residents were hospitalized repeatedly. His research showed that about 1 percent of the 100,000 people who made use of city medical facilities accounted for 30 percent of system costs. Although super-utilizers compose only about 5 percent of patients nationwide, their care accounts for almost 50 percent of U.S. healthcare spending, according to the U.S. Agency for Healthcare Research and Quality.