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Sacramento Bee

March 5, 2010

Sutter program targets frequent ER visitors

Lorene Duran, 43, was "in and out of hospitals a lot" with bronchitis, pneumonia, depression and anxiety before she was signed up for the T3 program created by Sutter Medical Center and a nonprofit community clinic called The Effort. Duran, a former methamphetamine user, is one of the people who was steered to services such as housing, and drug and medical treatment by T3 officials in an effort to keep them from frequent, costly visits to the ER.
Lorene Duran, 43, was "in and out of hospitals a lot" with bronchitis, pneumonia, depression and anxiety before she was signed up for the T3 program created by Sutter Medical Center and a nonprofit community clinic called The Effort. Duran, a former methamphetamine user, is one of the people who was steered to services such as housing, and drug and medical treatment by T3 officials in an effort to keep them from frequent, costly visits to the ER.

By Cynthia Hubert

The mental patient in the midst of another anxiety attack. The homeless diabetic with recurring kidney problems. The drug addict with one in a series of infections.

Specialists in Sutter General Hospital's emergency room in midtown Sacramento patched them up, sent them out the door and were never surprised when they returned, weeks or months later, sometimes dozens of times in a year.

It was a costly cycle, both in human and financial terms. So Sutter found a better way of dealing with "frequent flier" patients.

Working with a nonprofit community clinic called The Effort, the hospital identified dozens of patients who regularly showed up in the ER with routine problems, assigned them case managers and linked them with services including drug treatment, mental health counseling, primary health care and housing.

The groundbreaking program, called T3, is reducing emergency room visits, saving the hospital money and dramatically improving the lives of participants, officials said.

"This program changed everything for me," said Brian McMillan, a former heroin addict. When he was homeless, uninsured and shooting heroin, McMillan, 46, would end up in the hospital five or six times a year for four to 10 days at a time. He also had a long list of misdemeanor criminal offenses tied to his addiction.

A T3 client since 2007, he's now clean and sober, healthy, law-abiding, and no longer hits the emergency room when he has a minor problem. He receives a monthly Social Security check, has insurance coverage through Medi-Cal and lives in a cottage at Martin Luther King Village, a supportive housing complex in south Sacramento for formerly homeless people.

Participants in the program, called T3 for Triage, Transport and Treatment, have cut their emergency room visits by 65 percent, and 80 percent of them have stopped or "significantly reduced" their substance use, according to Sutter. Their inpatient hospital stays have been slashed by 37 percent. Fifty of 85 clients have found permanent housing at MLK Village.

Sutter and The Effort plan to expand T3 to serve 200 clients, potentially saving the hospital $2.4 million a year, said Sutter Medical Center chief executive officer Tom Gagen. The program has been expanded to Sutter Memorial, and recently was recognized by the American Hospital Association as a model innovative program.

Hospitals have long struggled with how to handle medically indigent patients.

"Often, they come for routine care, colds, the flu, a hangnail," said Jonathan Porteus, clinical director of The Effort. "They don't feel they have any other place to go, so the ER gets filled up with people who do not have urgent needs. It's very expensive to treat them, and they're not getting long-term help."

Frustrated with the situation, Keri Thomas, Sutter General's community benefits manager, identified hundreds of patients who had visited the ER four or more times during a six-month period.

She found that many had no regular doctor or health coverage. Some were chronically homeless; others had recently lost jobs and were living on the edge.

Working with Porteus, Thomas and others pitched a plan that would place case managers from The Effort in the Sutter emergency room.

They would interview "frequent fliers" and immediately link them to a variety of services, from primary medical care to drug rehabilitation and mental health counseling. The Effort would even provide transportation and help clients apply for insurance coverage and other aid. Participants would live temporarily in a rented "T3 House" until they qualified for programs such as Social Security and Medi-Cal and found low-cost, permanent housing.

Sutter committed $500,000 for a two-year pilot program in 2007, and in October gave The Effort a $730,000 grant to continue the program.

"It works because it's treating the whole person," Porteus said of the approach. "You can't get stable until you have a place to live."

Dr. Kelly Nations, Sutter's emergency room director, said T3 has been good for the hospital and patients. "We're no longer saying, 'There's Mr. Jones again.' Because Mr. Jones now has appropriate follow-up care. He's not bouncing back to us."

Lorene Duran fits the profile.

Duran, 43, was "in and out of hospitals a lot" with bronchitis, pneumonia, depression and anxiety before she embraced T3.

"It was ugly. It was terrible," said Duran, a former methamphetamine user who once lived on the streets of Sacramento.

Today, after qualifying for T3, Duran is free of her drug addiction, on prescription medications for her mental issues and lives quietly at MLK Village. A portion of her Social Security check pays the rent.

"I hit the bottom, and that was it," Duran said. "But now I'm climbing out. My life is the opposite of what it was before, and it's a blessing."

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