Our teaching clinic, the Duke Outpatient Clinic (DOC), is serious about managing complex patients, those individuals who are sometimes labeled by the ED and hospital as "frequent flyers". A new program called "HIDOC" stands for "Highly Individualized, Dedicated Onsite Care" began this year and is led by 4 Duke GIM faculty members: Drs. Lynn Bowlby, Alex Cho, Patrick Hemming, and Jacob Feigal.
"HIDOC has allowed us to step up our on site treatment of acute medical issues and use the power of care management and team discussions to build robust care plans for our medically complex patients," says Lynn Bowlby, MD.
Often labeled as "high utilizers" this group of patients are typically vulnerable populations with complex social and behavioral health needs. The top 5% of this population account for approximately 50% of overall health care expenditures. In the DOC these patients will receive planning and coordinated health care services, even access to a set-aside treatment room as necessary for needs such as intravenous fluids or breathing treatments. The idea is that access to care and preventive treatment can make a difference, especially in management of chronic conditions such as asthma, heart disease, and diabetes.
The goal is timely and appropriate care to reduce the number of ED visits and hospitalizations.