Blockbuster Moment

English: Camden, New Jersey is one of the poor...
English: Camden, New Jersey is one of the poorest cities in the United States. Camden suffers from unemployment, urban decay, poverty, and many other social issues. Much of the city of Camden, New Jersey suffers from urban decay. 日本語: ニュージャージー州カムデンのスラム. Svenska: Camden, New Jersey is one of the poorest cities in the United States. Kiswahili: Camden, New Jersey ni moja ya mataifa maskini zaidi katika miji ya Marekani. (Photo credit: Wikipedia)

Dr. Jeffrey Brenner, a family physician in Camden, New Jersey, talks about this as being a Blockbuster Moment in US health care in the US, a time for game changing innovations. He is the head of one such health care game-changer, the Camden Coalition of Healthcare Providers.

Camden, New Jersey is one of the poorest and most crime-ridden cities in the US. After completing his residency in family medicine here in Seattle in the late 1990’s, Dr. Brenner returned to his hometown of Philadelphia to establish a family practice. But a series of events–including the murder of young man outside his house– led him out of his private practice and into community work in nearby Camden.

Working with hospitals and local physicians, Dr. Brenner was able to map and identify the high utilizers of health care–people who were the most medically complex and the most expensive to treat. He found that 1% of the Camden residents accounted for 30% of all hospitals charges, mostly for emergency department visits for health problems that could have been treated and prevented with primary health care. After some good old-fashioned community coalition building, Dr. Brenner and his group hired a team of nurse practitioners, social workers, and community health workers to work with the “high utilizers” to help coordinate their health care, housing, benefits and other needs. The Camden Coalition model of care is showing results indicating they are able to provide better health care at lower cost to the most difficult to treat patients in one of the poorest cities in the US. As Dr. Brenner states, “If Camden can do it, it makes the rest of the country look silly.”

There is a very good 13min PBS Frontline video “Doctor Hotspot” by Atul Gawande highlighting the work of the Camden Coalition of Healthcare Providers. It features an interview with Dr. Brenner and also follows Coalition nurse practitioner Kathy Jackson on a home visit with one of her patients, a young man with asthma and a seizure disorder. Through her work with this young man, his ER visits went from 35 over six months to just 2 over six months.

In the Frontline video, Atul Gawande points out to Dr. Brenner that “there’s a catch” to the work of the Coalition being too successful. The catch is that they are taking away from the hospitals their most expensive, most lucrative patients and the hospital administrators will resist that change.

Atul Gawande also published an interesting article “The Hot Spotters” related to Dr. Brenner’s work in the New Yorker (1-24-11).

Also–for anyone with a NJ RN license, check out the two open RN positions on the Camden Coalition of Healthcare Provider’s website. They both look like exciting jobs with a terrific team. They also have volunteer opportunities listed.

Complications/ September 28, 2010

Yesterday I started reading Atul Gawande‘s book Complications: A Surgeon’s Notes on an Imperfect Science. It is good and I briefly considered taking it with me to Virginia to read while I am caring for my Dad. The cover photograph is a bit disturbing to flash around in a hospital waiting room though. I decided to take something more soothing and distracting, so Dicken’s An Uncommercial Traveler is accompanying me instead. His chapter “Nurse’s Stories” has given me the idea to tell my father ghost stories when he’s in the hospital.
I have read all of Gawande’s recent New Yorker essay: “Letting go: what medicine should do when it can’t save your life” (available at Gawande’s website: http//gawande.com). His main point in this article is that US doctors–and US patients— just aren’t very good at “knowing when to stop” expensive treatments even when the benefits aren’t clear. What interested me the most was his reference to a study of Medicare patients with heart failure who I assume were randomized to either conventional or hospice care. The patents in hospice care lived on average 3 months longer than the conventional care patients (and I also assume with better quality of life). That study finding may come in handy this next week in discussions with my Dad and with his doctors. Gawande discusses how the tough ‘breakpoint discussions” (when to stop fighting for time/life) between patients and doctors aren’t done very often because the discussions take time and aren’t reimbursable/billable activities. I also think it is because doctors often view these discussions as failures because they are hard-wired for curing and not for caring. I am interested to find out how my Dad’s doctors handle this–and how my Dad and I will handle it. A difficult conversation or series of conversations. My Dad told me last night he’s getting tired more easily and he hopes the cardiac surgeon can fix that soon.