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. 2023 Nov 23;23(1):1289.
doi: 10.1186/s12913-023-10236-w.

Caring for high-need patients

Susanne Hempel  1 , Maria Bolshakova  2 , Michael Hochman  3 , Elvira Jimenez  4 , Gina Thompson  2 , Aneesa Motala  2 , David A Ganz  4 , Sonya Gabrielian  4 , Samuel Edwards  5 , James Zenner  6 , Ben Dennis  2 , Evelyn Chang  4
Affiliations

Caring for high-need patients

Susanne Hempel et al. BMC Health Serv Res. .

Abstract

Objective: We aimed to explore the construct of "high need" and identify common need domains among high-need patients, their care professionals, and healthcare organizations; and to describe the interventions that health care systems use to address these needs, including exploring the potential unintended consequences of interventions.

Methods: We conducted a modified Delphi panel informed by an environmental scan. Expert stakeholders included patients, interdisciplinary healthcare practitioners (physicians, social workers, peer navigators), implementation scientists, and policy makers. The environmental scan used a rapid literature review and semi-structured interviews with key informants who provide healthcare for high-need patients. We convened a day-long virtual panel meeting, preceded and followed by online surveys to establish consensus.

Results: The environmental scan identified 46 systematic reviews on high-need patients, 19 empirical studies documenting needs, 14 intervention taxonomies, and 9 studies providing construct validity for the concept "high need." Panelists explored the construct and terminology and established that individual patients' needs are unique, but areas of commonality exist across all high-need patients. Panelists agreed on 11 domains describing patient (e.g., social circumstances), 5 care professional (e.g., communication), and 8 organizational (e.g., staffing arrangements) needs. Panelists developed a taxonomy of interventions with 15 categories (e.g., care navigation, care coordination, identification and monitoring) directed at patients, care professionals, or the organization. The project identified potentially unintended consequences of interventions for high-need patients, including high costs incurred for patients, increased time and effort for care professionals, and identification of needs without resources to respond appropriately.

Conclusions: Care for high-need patients requires a thoughtful approach; differentiating need domains provides multiple entry points for interventions directed at patients, care professionals, and organizations. Implementation efforts should consider outlined intended and unintended downstream effects on patients, care professionals, and organizations.

Keywords: Care stakeholders; Environmental scan; Expert panel; High need patients; Key informants.

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Conflict of interest statement

The authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.

Figures

Fig. 1
Fig. 1
Need domains of high-needs patients, their healthcare professionals, and care organizations Note: Bolded domains were rated as essential, domains rated as important are also shown (not bolded)
Fig. 2
Fig. 2
Intervention Categories Note: Size of the bar is proportionate to the number of times chosen as essential, a black frame indicates a mean rating of essential
See this image and copyright information in PMC

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