SFGH- Department of PsychiatryEmergency Department CaseManagement Program (EDCM)September 24, 2012
Kathy O’Brien, LCSW
Program Coordinator
415-206-5071
kathy.o’brien@sfdph.org
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San Francisco General Hospital andTrauma Center
San Francisco General Hospital and Trauma Center is the soleprovider of trauma and psychiatric emergency services for theCity and County of San Francisco. A comprehensive medicalcenter, SFGH serves some 100,000 patients per year andprovides 20 percent of the city’s inpatient care.
SFGH BY THE NUMBERS ‘10-’11
598 licensed beds
102,000 patients treated
20% of all inpatient care in San Francisco
1,170 babies born
63,000 Emergency visits (medical & psych)
22,000 Urgent Care visits
3,900 Trauma activations
30% of all ambulances come here
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San Francisco General Hospital andTrauma Center
SFGH BY THE NUMBERS ‘10-’11- con’t
550,000 outpatient visits
Approximately 2,600 City and 1,600 UCSF
Employees (FTEs)
32% of all UCSF resident training
$92.3 million in charity care provided in
FY2008—75% of all charity care provided in SF
Provides 93% of the inpatient care for
Healthy San Francisco enrollees
1 of 13 Emergency medicine residencies in CA
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Start Up of Program
1993-1994
Collaboration between Dept of Psychiatry &Dept of Medicine
Chart review:
202 pts with 12 or more visits out of 49,499
0.0041 % yet 11 times more likely to useMER
1995
Approved by Health Commission / Dept. ofPublic Health
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Demographics
Gender:
85% males15% female
Race / Ethnicity:
59% African American
31% Euro-American
03% Native American
07% Latino
Homeless 82%
Uninsured 48%
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EDCM Team
5 Social Work Case Managers
1 Primary Care Physician .50
1 Nurse Practitioner .80
1 Psychiatrist .25
1 Pharmacist .10
1 Social Work Supervisor and Screener
Program Coordinator
Administrative Assistant
SW Intern
Peer Specialist
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Services
Case Management / Brokerage services
Crisis Intervention
Group and Individual Counseling
Medical Assessment and Care
Psychiatric Assessment and Care
Assertive Outreach
Socialization opportunities
Coordinated Voc Rehab Opportunities
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Eligibility and Referrals
5 or more visits to SFGH MER in past 12months or HUMS client
18 years or older
San Francisco resident
Not enrolled in duplicative CM program
Voluntary nature of services
Screening and pending status
Primary sources of referrals
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Eligibility and Referrals
Referrals are from :
Medical ED
IP Social Workers
DPH HUMS project
Dept. of Psychiatry
Community agencies
Collaboration with Health Plans
Collaboration with COPC Care teams
SF Private non-profit hospitals
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Outcomes Studies
1995-1996 Convenience sample of 174patients resulted in study of 53 casemanaged people
Lowered ED costs
Lowered IP costs
Decreased rates of homelessness, substanceabuse
Improved linkages to primary care
Net cost savings
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Research DesignRandomized Trial
252 high users of SFGH ED were:
Stratified by ED utilization into LoHiand HiHi users
Randomized to CM (2/3) or UC (1/3)
Followed every 6 months for 24 months
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Research DesignRandomized Trial
84% of the 167 randomized to CM enrolledwith EDCM
No differences in terms of age, gender orethnicity between those who enrolled or not
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Results of Randomized TreatmentStudy: ED Use
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Results of Randomized TreatmentStudy: IP Medical Days
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Results of Randomized TreatmentStudy: Problem Alcohol Use
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Results of Randomized TreatmentStudy: Homelessness
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Results of Randomized TreatmentStudy: SSI / SSDI
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Results of Randomized TreatmentStudy: Health Insurance
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Who are we talking about
“Lily”
“El Diablo”
“Jake”
“Sadie”
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Nature of Case Management
Outreach and engagement
Clinical nature of the work
Considerations for staff mix
Appreciate the complexity of patient life
Linkage (more than a call and referral slip)
Nature & receptivity of non-MER services
What we’re expecting patients to do
Change what may “work” already for them
Navigate complex support systems
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Transition and termination
“CM for life?”
“When is enough, enough?”
Mutual goals and review of progress
Gaps in service
Create ease of service can also raisedependency
CM own reluctance to close case
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Other SF Initiatives
DPH-Focus on High Users of MultipleSystems (HUMS)
DPH- Housing and Urban Health
Housing first model
Eligibility criteria
Other housing options (respite to permanent)
DPH- Integrated Delivery System
2011-2012 planning process
Areas for change implementation
DPH- Clinic based care management teams
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Questions?
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