The AAMC has a new initiative to teach the next generation of physicians about ‘hot spotting’ and its role in providing high quality care while reducing costs. They have developed a toolkit to assist any medical student, resident, attending, or community physician in conducting their own hot spotting project with a patient from their practice.

I was immediately taken in by hot spotting when I read about in Atul Gawande’s 2011 New Yorker piece [1]. Around the same time, I heard about a research group that was taking a ‘80/20’ approach to prioritizing their initiatives. They were going to look at the 20% of diagnoses that accounted for 80% of their admissions. Electronic medical records enable both strategies and are good examples of using ‘big data’ to direct our efforts.

The initiative and toolkit put together by the AAMC is impressive. Their ‘10 Steps to Hot Spotting’ lays out a framework for comprehensively evaluating a patient who frequents the hospital.

A few thoughts:

Absolutely fantastic that their steps include going outside the hospital and clinic. Medical training should include more time for trainees in places providing supportive services (i.e.–nursing homes, physical rehab centers, shelters, mental health centers, etc).
Step 2 (essentially identifying the patient) seems like a high bar to pass. Their strategy requires (1) an excellent relationship with a specific care provider in an area likely to see candidate patients and (2) that person to recognize a suitable patient and contact the med student.
As written, their 10 steps don’t seem to incorporate identification of a mentor. I think–for med students especially–it would be very beneficial to have a mentor, especially if you can find someone with quality improvement experience/interests.
The final step should be presenting all of this at Grand Rounds!! If someone spent the time and effort to put together all of the materials described here, it would make for an amazing presentation. And don’t forget to include the patient (if possible).
This would make for a great project to include in quality improvement classes, which should be requisite for med school graduation. I wonder if such a project would count as quality improvement for board certifications now requiring a QI project [2].

Very to excited to see what comes out of this initiative. I think this is an excellent tool for introducing trainees to population-based health without the scary (and often boring) aspects of epidemiology and biostatistics.

Of course, part of that was due to Dr Gawande’s great storytelling. ↩
For example, the American Board of Pediatrics now requires a pediatrician to complete a quality improvement project as one of four parts to their new Maintenance of Certification. I believe (but don’t know for sure) that other specialties are doing similar things. ↩