With debilitating chronic obstructive pulmonary disease, congestive heart failure and Gitelman's syndrome, causing kidney problems and low potassium levels, Theresa Brown has become very familiar with the emergency room.
From a hospital bed in January, the 51-year-old Cedar Rapids woman was asked when she last visited the emergency room at St. Luke's Hospital.
"I was in here yesterday twice and they sent me home," she said. "But then things got worse."
In 2011, Brown -- who is not plagued by financial woes or insurance concerns -- visited the emergency room 12 times. She said her illness, acquired while working near chemicals, simply needs a lot of emergent care, and she often can't wait for an appointment with a doctor.
Still, officials with St. Luke's Hospital in Cedar Rapids wondered if there wasn't a way to help Brown and others like her reduce their trips to the emergency room.
In 2012, the hospital launched an Emergency Department Consistent Care Program with a $50,000 grant from Transamerica.
The goal was to identify patients who had visited the emergency room 12 or more times within a 12-month period and give them alternatives to costly emergent care. Brown and 102 other patients initially qualified for the program, which helps connect patients with primary care providers and coordinate patient visits with doctors, home care and mental health care.
After one year on the program, that group -- which logged a combined 1,679 visits to the emergency room in 2011 -- reduced their total combined visits to 537.
The program's success has made it a permanent fixture at the hospital. And the growing problem of frequent fliers to emergency rooms nationwide has other Eastern Iowa facilities considering similar measures.
"We have met with St. Luke's about their program and discussed the program with them and how we might incorporate some of their efforts to improve what we are doing here," said Tom Moore, spokesman for the University of Iowa Hospitals and Clinics.
Since the inception of St. Luke's consistent care program, participation has swelled to more than 225 patients. Officials add participants monthly by running reports of visits to the emergency room.
For every person in the program, a committee develops a care plan and presents that plan to each patient's primary care provider -- or finds them one. The team also helps patients find transportation to doctors' visits, resolve insurance issues or address other reasons for their frequent emergency room trips, said Sallie Selfridge, case manager for the program and St. Luke's social worker.
The care plan remains in place whether a patient agrees to it or not. And although it doesn't change the level of care they receive when they do visit the emergency room, it can be helpful for doctors to see the plan and have a quick view of past visits, Selfridge said.
"It's also great for the patient," Selfridge said. "Sometimes they don't realize how many times they've been in."
The program also restricts narcotic pain medication to participants. Patients might receive medication in the hospital, but they will not be discharged with the pills.
"We do have a few patients who come in looking for medication," Selfridge said.
As case manager for the program, Selfridge said she meets with patients to discuss reasons for their visits and to help them find other options.
If patients don't have insurance, Selfridge said, she helps them explore options and apply for aid. She also points them toward free medical clinics and other inexpensive community services.
Selfridge said emergency care is expensive and the number of visits at St. Luke's -- and nationally -- has been rising. St. Luke's emergency department logged 55,467 visits in 2012, up from 52,598 in 2010.
The hospital's new consistent care program costs about $100,000, but the success is proven, Selfridge said. Just 10 of the original 103 people who qualified for the program still do, and Selfridge said Iowa Health Systems is looking to roll out the program at its eight hospitals system wide -- including facilities in the Quad Cities and Fort Dodge.
The University of Iowa Hospitals and Clinics, although considering more programmatic changes like St. Luke's, already employs some methods of trying to curb unnecessary emergency room visits.
It holds open appointments in its clinic that sees IowaCare patients, those who would otherwise have no health insurance coverage.
"If they show up in the ER department and it's clear they don't need to be seen there, we can get them into the primary care department," UIHC spokesman Moore said.
The UIHC also has Quick Care locations for people who can't wait to schedule a doctor's appointment. And, Moore said, the hospital now is offering evening and weekend hours at its new Iowa River Landing location.
Mercy Medical Center in Cedar Rapids is in the process of developing an Emergency Department Navigator program, scheduled for implementation for this spring. The goal of that program is similar to the one at St. Luke's in that it aims to help frequent emergency room patients find a primary care provider for ongoing needs, said Mercy spokeswoman Karen Vander Sanden.
The navigator program also will focus on making sure patients understand their discharge instructions when they leave the emergency room and feel comfortable caring for themselves or a loved one, according to Vander Sanden.
Brown said that although St. Luke's program hasn't eliminated her trips to the emergency room, it has been beneficial in getting her the right care outside of emergency situations.
"It has helped me find specialists and lung doctors," she said, adding that she's been meeting with a case manager for "quite some time."
"And she helps me out a lot," Brown said. "She talks me through problems I have, and it makes my day. I'm very appreciative of all that." ___