P. Bedoya is assistant professor, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia. K. Neuhausen is clinical assistant professor, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia. A.W. Dow is Ruth and Seymour Perlin Professor of Internal Medicine and Health Administration and assistant vice president of health sciences for interprofessional education and collaborative care, Virginia Commonwealth University, Richmond, Virginia; ORCID: http://orcid.org/0000-0002-9004-7528. E.M. Brooks is instructor, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia. D. Mautner was assistant professor, Department of Family and Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, at the time of the study. R.S. Etz is associate professor, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
Acad Med. 2018 Jan;93(1):56-59. doi: 10.1097/ACM.0000000000001822.
Individuals with complex health and social needs drive much of the total cost of care. Addressing these individuals' needs and decreasing costs requires interprofessional teams, called "hotspotters," who engage with communities with high utilization. Training health professions students to succeed in the hotspotting approach may benefit trainees, academic health centers (AHCs), and communities.
The Camden Coalition of Healthcare Providers and the Association of American Medical Colleges launched the Interprofessional Student Hotspotting Learning Collaborative in 2014. The goal was to train health professions students working in interprofessional teams at U.S. AHCs to meet the needs of complex patients, providing home visits and intensive case management for up to five patients over six months. The authors report themes from 20 reflections from the five-student Virginia Commonwealth University (VCU) team.
Across 10 sites, 57 students participated during June-December 2014. The review of the VCU experience demonstrated that the hotspotting program was successful in teaching students how social determinants affect health and the benefits of interprofessional teamwork for addressing the unmet health and social needs of complex patients. Key elements that students identified for improvement were more program structure; protected time for program activities; and formalized processes for recruiting, retaining, and transitioning patients.
Future iterations of the program should strengthen the curriculum on caring for complex patients, provide protected time or academic credit, and formally integrate teams with primary care. A larger study evaluating the program's impact on patients, health systems, and communities should be undertaken.
具有复杂健康和社会需求的个体是医疗保健总成本的主要驱动因素。为满足这些个体的需求并降低成本，需要跨专业团队（称为“热点发现者”）与高利用率的社区合作。培训卫生专业学生成功采用热点发现方法可能使培训生、学术医疗中心（AHC）和社区受益。
2014 年，卡姆登医疗保健提供者联盟和美国医学协会启动了跨专业学生热点发现学习协作。目标是培训在美国 AHC 中以跨专业团队工作的卫生专业学生，以满足复杂患者的需求，为多达五名患者提供为期六个月的家访和强化病例管理。作者报告了来自弗吉尼亚联邦大学（VCU）五名学生团队的 20 份反思中的主题。
在 2014 年 6 月至 12 月期间，10 个地点共有 57 名学生参与。对 VCU 经验的回顾表明，热点发现计划成功地教授了学生社会决定因素如何影响健康，以及跨专业团队合作解决复杂患者未满足的健康和社会需求的益处。学生们确定需要改进的关键要素包括：更多的项目结构；为项目活动提供保护时间；以及为招募、保留和过渡患者制定正式流程。
该计划的未来迭代应加强对照顾复杂患者的课程，提供保护时间或学术学分，并正式将团队与初级保健相结合。应进行更大规模的研究，评估该计划对患者、卫生系统和社区的影响。
