MISSOULA – A group of graduate students at the University of Montana recently participated in an experience they say has fundamentally challenged the way they view American health care.
The students were part of a select, interdisciplinary group from UM’s College of Health that provided intensive, holistic support to a single patient struggling to navigate today’s complicated health system. The experience was part of the Montana Interprofessional Student Hotspotting program.
The goal of Hotspotting is not to provide clinical care, per se, but to work alongside a patient and connect missing dots when it comes to their ability to attain health. More often than not, health obstacles are related to a patient’s “social ecosystem,” said Jennifer Bell, director of clinical education in UM’s School of Physical Therapy and Rehabilitation Science and co-director of Student Hotspotting. This might include food insecurity, insufficient housing or feelings of isolation and loneliness, Bell said.
“For many people in our community, the health care system is broken,” Bell said. “Patients who struggle within their social environment, for example, can end up overusing emergency care with little impact on their long-term health or goals,” said Bell, noting that these issues have been exacerbated by the COVID-19 pandemic.
Now in its third year at UM and the only program of its kind in Montana, the Montana Interprofessional Student Hotspotting program is funded by the Montana Health Care Foundation and the Montana Geriatric Education Center. The program pairs UM graduate students from physical therapy, psychology, pharmacy, public health, speech, language and hearing sciences and social work for six, intensive months of working with a patient identified by Missoula’s Partnership Health Center. The program also includes students from Montana State University nursing programs.
The group meets on a weekly basis with the patient, attends their medical appointments and identifies potential issues holding the patient back from attaining robust health.
Gabriella Ji, a UM clinical psychology student and Hotspotting student, said her front-row seat to participating in an integrated way with other students in health care will help her become a better practitioner.
She said the experience allowed her to widen her view of health care and humbled her understanding of what a patient experiences when they’re not being understood.
“From a psychology perspective and working with other students in health care like nutrition, physical therapy and pharmacy, I realized we each have our own jargon and ways of communicating,” Ji said. “That kind of language doesn’t always translate to the patient, and it keeps us operating in silos. So, I learned a lot about terminology and communication from different areas of health care, and I found I was able to help my colleagues think about their approach and language when working with a patient.”
Ji said the Hotspotting experience has encouraged her to seek advice and support from other health care disciplines as she plans to eventually pursue counseling work with a veteran population.
Charles Rourke, an outreach administer for Partnership Health, said the Hotspotting program helps patients who are labeled as “complex” or “high needs” to see themselves in a different light and navigate a path to better health.
“Every UM student that comes through this program has learned something about helping patients navigate a medical system,” Rourke said. “For many of these patients, they are discouraged, without a lot left to give. To gain a better understanding of a person, we have to see them as more than their diagnosis and understand that health is process-oriented and often has more to do with a person’s social ecosystem than we realize.”
For Reece Brandon, a UM physical therapy and Master of Public Health student, that means drawing parallels between a person who doesn’t own a car and their ability to regularly attend health care appointments. Or, understanding that if a person is homeless, physical therapy exercises probably aren’t a priority.
“The tricky thing about this experience is that it required us to assist these patients in a non-clinical way,” Brandon said. “I think the most important aspect for me, as a future healthcare provider, is a deeper understanding and appreciation that individual things that people struggle with are bigger than what the health care system gives them credit for.”
Brandon said he observed the ways doctors can interrupt patients and not always use respectful terms, or even take into account challenges with basic needs like a patient’s stress levels or access to reliable transportation.
“The patient that we worked with had a very low level of trust in the health care system,” Brandon said. “And it was our job, as a group, to place the relationship with the patient at the center and have them be in charge of their care and their investment in their health outcomes, which is a model that’s in opposition of the way most healthcare is framed.”
The patient Brandon worked with had used emergency medical services seven times in one year. After participating in the Hotspotting program, this patient only used emergency service once.
Kate Chapin, co-director for Student Hotspotting and Project Evaluator for the UM Center for Families and Workforce Development, said about 5% of the U.S. population consumes nearly 50% of health expenditures in an already burdened and burnt out health care workforce. She said the likely cause of health care services overuse has more to do with a person’s unmet social needs than anything else.
“Unmet social needs are exacerbating poor health outcomes not only in our community, but across the country,” Chapin said. “And since the onset of COVID-19, we’ve seen an unfortunate uptick in poor health outcomes directly related to food, affordable housing, transportation, isolation, and loneliness making conditions worse for people who are already struggling with their health.”
Chapin said the modern medical model of doctor-instructs-patient doesn’t always serve a large percentage of patients who need “a wider lens of care.”
“Our students have an opportunity to practice a truly, integrated healthcare model that is patient-driven,” Chapin said. “Not only does it provide a transformative learning experience for our students – that we hope they take with them into the field – but the actual, overall health outcomes for the patients are far better with this integrated approach.”
Contact: Jennifer Bell, program director, UM Clinical Education, associate professor, School of Physical Therapy and Rehabilitation Science, 406-243-6827, email@example.com, or Kate Chapin, UM Center for Children, Families and Workforce Development, firstname.lastname@example.org.