New "HotSpotting" Initiative Connects Patients to Care

Released on May 4, 2015

Patients with complex medical needs in Saskatchewan will be better served thanks to a new health care initiative.  Two planned “hotspotting” pilot projects are now underway in the province.

Connecting to Care uses an innovative, patient-centred care model that identifies patients with complex needs who repeatedly need hospital services or visit emergency departments.  A team of providers helps these patients receive alternative, more appropriate services in the community and follows up to ensure they are supported in improving their health.

“Our health system needs to better meet the needs of patients who have complex health issues,” Health Minister Dustin Duncan said.  “This innovative pilot project will mean more coordinated, accessible and appropriate health services for these patients, and fewer preventable visits to the hospital.”

A Regina pilot project has enrolled 25 clients to date.  It focuses on patients with chronic health conditions who have repeatedly been admitted to hospital for acute care.

“These clients have taught us a lot about the need to deliver services differently,” Regina Qu’Appelle Health Region Executive Director of Primary Health Care Services Urban Sheila Anderson said.  “By offering consistent support and helping clients connect to community services, we have been able to make a real difference.”

The multidisciplinary team coordinating client care includes a Primary Health Care nurse and Primary Health Care counsellor who provide services based on individual needs.  Two client wellness advocates assist with health education, help clients navigate health services and act as patient liaisons.  The team works with physicians and other health care providers in the community to develop co-ordinated patient plans that complement and support existing care.

“It has been a unique and exciting opportunity to work with the Connecting to Care team,” Wellness Advocate Client Jon Heathcote said.  “With our focus on prevention and timely, effective community-based support, I have already seen a positive change in our clients’ lives.”

Recent national and international analysis shows that a very small number of patients account for most health system costs.  Data from the Health Quality Council indicates that, in Saskatchewan, one per cent of patients account for approximately 21 per cent of hospital costs.

Connecting to Care is expected to help avoid preventable hospital admissions for patients and, over time, improve the sustainability of the health care system by curbing health care costs.

A second pilot project is underway in Saskatoon.  It focuses on patients with mental health and addictions issues.  Saskatoon Health Region is in the process of putting together the team, comprised of a manager, nurse practitioner, psychologist, case managers and an Elder, to work on this initiative and will begin working with clients as soon as hiring and orientation is complete.

Government of Saskatchewan provided $1.5 million in 2014-15 for Connecting to Care, including the two pilot projects.  Future funding and program expansion will be based on positive evaluation results.  Connecting to Care will support other provincial health care priorities, including the emergency department wait time project and the Mental Health and Addictions Action Plan.

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For more information, contact:

Tyler McMurchy
Health
Regina 
Phone: 306-787-4083
Email: tmcmurchy@health.gov.sk.ca

Miriam Johnson
Regina Qu’Appelle Health Region
Regina 
Phone: 306-766-5365
Email: miriam.johnson@rqhealth.ca