Researchers thought they had a way to keep hard-to-treat patients from constantly returning to the hospital and racking up big medical bills. Health workers visited homes, went along to doctor appointments, made sure medicines were available and tackled social problems including homelessness, addiction and mental health issues.
Readmissions seemed to drop. The program looked so promising that the federal government and the MacArthur Foundation gave big bucks to expand it beyond Camden, N.J., where it started.
But a more robust study released Wednesday revealed it was a stunning failure on its main goal: Readmission rates did decline, but by the same amount as for a comparison group of similar patients not in the costly program.
“There’s real concern that the response to this would be to just throw up our arms” and say nothing can be done to help these so-called frequent fliers of the medical system, said study leader Amy Finkelstein.
Instead, researchers need to seek better solutions and test them as rigorously as new drugs, said Finkelstein, of the Massachusetts Institute of Technology and the National Bureau of Economic Research.
Federal grants and research groups at MIT paid for the study, which was published in the New England Journal of Medicine.
Just 5 percent of the U.S. population accounts for half of health care spending, and hospitalization is a big part.
A decade ago, Dr. Jeff Brenner started working with hospitals in Camden, a city with high poverty and crime rates, to identify people who go to hospitals frequently and target them with special services.
The program was “clearly done with the best of intentions” and still may have provided useful care to the people who received it even though it didn’t reduce readmissions, said Dr. Aaron Kesselheim, a Harvard Medical School health policy expert who had no role in the work.
Problems like readmission are much more complicated than they appear to be, he said.
