A City of San Diego program that uses IT-enabled identification of frequent users of emergency services saves the city an estimated $700,000 per year, and also cut the number of encounters with frequent callers by 38 percent in its pilot phase.
Known as the Resource Access Program (or "RAP"), the initiative uses health information technology that immediately recognizes and notifies a program coordinator whenever a frequent user of emergency services calls 911. The RAP coordinator, an experienced paramedic, then alerts a network of community stakeholders (physicians, social workers, police officers, case managers, and housing providers) and works with them to implement measures to address the caller's immediate and underlying health and social service needs.
A computer software tool called Street Sense, linked to the regional health information exchange (San Diego Connect), uses algorithms to identify whether the patient placing an EMS call is a frequent caller, highlighting key issues such as history of substance abuse, psychiatric problems, and in-home falls. If the patient has been previously identified as a frequent user by the RAP coordinator, Street Sense automatically pages the coordinator and, in some cases, other members of the patient's care team. The RAP coordinator may then meet the patient in the ED to assist the emergency physician in determining an appropriate followup plan or, less commonly, respond directly to the scene of the incident.
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