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Right-sized care: acute intervention in an ambulatory setting

As a pediatrician, I find that there are times when my patients require a specific acute intervention – but they don’t need the full hospital experience. For example, when infants and children are dehydrated and need intravenous fluids, outpatient physicians, patients and their families may benefit from having alternatives to the local emergency room.

Outpatient clinics face many scenarios when an intermediary care setting would be ideal. Holston Medical Group (HMG), a large multi-specialty physician group based in Kingsport, Tennessee, U.S.A., has developed its own response to this challenge: The Extensivist Clinic.

Addressing needs of high-risk patients

HMG saw an opportunity to better manage patients who have multiple chronic conditions. This population includes seniors and patients with highly complex needs who represent more than half of the costs of the organization.

Outpatient clinicians typically seek assistance from high-cost care settings – such as emergency rooms or hospitals – to manage difficult co-morbidities and crises. But HMG’s hospital team of physicians recognized that hospitalization often adds stress for patients, and can make it difficult for patients to eat, sleep and regain their health.

HMG’s goal was to create a care setting in which patients could receive specialized interventions over the course of multiple days to stabilize their conditions, avoiding hospitalizations. This option would then improve quality and coordination of care, reduce costs associated with high-risk patients and increase patient satisfaction.

The Extensivist Clinic offers alternative to acute care settings

The Extensivist Clinic opened in 2013 and offers patients up to 10 hours of treatment a day, Monday through Friday. Typical conditions treated at the clinic include chronic heart failure (CHF) decompensation, chronic obstructive pulmonary disease (COPD) exacerbations, pneumonia, dehydration, early sepsis and more.

Access to the OnePartner HIE, powered by Allscripts dbMotion™ Solution, is especially important for HMG’s Extensivist Clinic staff, who provide care to patients with complex needs on an outpatient basis. The community record provides up to date information about the patient, such as medication changes, ancillary services or referrals. With local hospital data also flowing into the HIE, HMG’s clinicians are better able to manage transitions of care and avoid unnecessary readmissions.

HMG patients are fortunate to have access to the Extensivist Clinic, where they receive an increased level of care in a less expensive, less invasive environment. There is also significant opportunity to improve the quality of care by facilitating smooth transitions of care and sharing inpatient and outpatient medical information on behalf of the patient.

To learn more about HMG’s success with value-based initiatives, download a free case study.

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