Title: Operation Care
Organization: HealthCare Access Maryland, Inc. (HCAM)
Innovation type: Access Program
What They’re Doing: Provide case management, care coordination and linkages to medical and support services to remove barriers to health care for persons frequently calling 911 for non-emergent reasons and/or poorly managed medical conditions
Clinical Innovation: Patients referred over by the Baltimore City Fire Department (BCFD) are assigned either a RN case manager or case manager depending on their needs. Case managers provide outreach (i.e. home visits, street, site-based, etc.) to locate the patient. Case managers complete a thorough medical and psychosocial assessment with the client and develop a mutually agreed upon care plan. Patients are assigned to intensive, intermediate or limited case management; as the patient’s needs are addressed and their call volume decreases the intensity of the case management services changes. Case managers assist the patient with accessing/coordinating medical, specialty care and support services to remove barriers to health care. Clients are linked to wrap around services such as personal care assistance and/or home health for on-going needs. Case managers provide on-going case management to ensure appointment compliance, resolution of needs and a decrease in 911 calls..
Evaluation Type: Quasi-Experimental.
Evaluation Plan: Efforts are underway to determine the actual and long-term costs savings of the program for BCFD and other systems (i.e. Emergency Departments, hospitalizations, re-admittance, etc.). The original pilot (May 12, 2008 – August 1, 2008) found a direct correlation between the reduction of calls and costs savings for BCFD. An evaluation done in May 2011, also found significant costs savings for BCFD. .
Patient Outcomes and/or cost outcomes: Collection of data for patient and cost outcomes is ongoing. In 2013, HCAM hopes to evaluate the first two years (2010-2012) of the fully funded program.
Other results of interest:
10 participants had 412 transport response calls between May 12, 2007 – May 12, 2008
9 (90%; N= 10) had health insurance but accounted for 405 (99%; N=412) of the transport response calls prior to the intervention. . 10 (100%; N=10) had two or more chronic disease or illnesses. . 7 (70%; N=10) had a mental health and/or substance abuse diagnosis.
Outcome- Main outcome measures were the number of transport and nontransport EMS responses to patients during the intervention as compared with predicted EMS responses based on each patient's previous year's EMS use. 7 (70%; N=10) had at least an 80% decrease in calls; approximate costs savings to BCFD $31,662 (Predicted Costs- $37,187; Actual- $5,525). . 32% decrease in transport responses over the 76 predicted transport responses during the intervention. 79% decrease in non-transport responses over the 24 predicted non-transport responses during the intervention
10 (100%; N=10) were successfully linked to two or more resources.
Publications: The American Journal of Emergency Medicine: “Operation Care: A Case Management Intervention for Frequent Emergency Medical System Users”; Authors: Michael L. Rinke, M.D.; Elisabeth Dietrich, BA; Traci Kodeck, MPH; Kathleen Westcoat, MPH
Target Population: Baltimore City residents who frequently call 911 for an ambulance; the calls are often for non-emergent reasons and/or poorly managed medical conditions.
Date of Implementation: May 2008 – August 2008; Partially Funded: 2008 – 2010; Fully Funded by the Baltimore City Fire Department: 2010 – Present.
Kibibi Matthews, M.S.
410.649.0521 Ext. 4003
Where to learn more: Kibibi Matthews