Impact of a complex chronic care patient case conference on quality and utilization

Abstract

There is need for effective venues to allow teams to coordinate care for high-risk or high-need patients. In addition, health systems need to assess the impact of such approaches on outcomes related to chronic health conditions and patient utilization. We evaluate the clinical impact of a novel case conference involving colocated trainees and supervisors in an interprofessional academic primary care clinic. The study utilized a prospective cohort with control group. Intervention patients (N = 104) were matched with controls (N = 104) from the same provider's panel using propensity scores based on age, gender, risk predictors, and prior utilization patterns. Clinical outcomes and subsequent utilization patterns were compared prior to and up to 6 months following the conference. In terms of utilization, intervention patients demonstrated increased visits with primary care team members (p = .0002) compared with controls, without a corresponding increase in the number of primary care providers' visits. There was a trend towards decreased urgent care and emergency visits (p = .07) and a significant decrease in the rate of hospitalizations (p = .04). Patients with poorly-controlled hypertension saw significant decreases in mean systolic blood pressure from 167 to 146 mm Hg. However, there were no differences between the intervention and control groups. Intervention patients with diabetes demonstrated a nonsignificant trend towards decreased hemoglobin A1c from 9.8 to 9.4, when compared with controls. Interprofessional case conferences have potential to improve care coordination and may be associated with improved disease management, decreased unplanned care, and overall reduced hospitalizations.

High‐need high‐cost patients: A Concept Analysis

“…Compared to the average US adult, HNHC patients spend more than twice as much on out‐of‐pocket expenses and nearly four times as much on overall health care services and medication, exceeding $21 000 for average annual per‐person spending 1,3 . Yet, interventions aimed to control costs and reduce unnecessary health care utilization in this population have proved largely ineffective, 4‐8 likely due to lack of consensus on the definition and characteristics of HNHC patients 8,9 …”

Analysis of the key themes in the healthcare of older people with multimorbidity in Germany: a framework analysis as part of the LoChro trial

“…However, on the patient level, only a few case conferences have taken place 26. A prospective matched cohort analysis of 208 patients could not demonstrate significant impacts of chronic care patient case conferences in primary care after 6 months 55. In addition, GPs reported the time to organise and coordinate these meetings as major barriers towards case conferences 56.…”

“…26 A prospective matched cohort analysis of 208 patients could not demonstrate significant impacts of chronic care patient case conferences in primary care after 6 months. 55 In addition, GPs reported the time to organise and coordinate these meetings as major barriers towards case conferences. 56 Nonetheless, the present results strongly support efforts to strengthen coordination of care within the outpatient sector and across different sectors on the patient level, in addition to general management conferences and disease-specific programmes.…”

Approaches to Addressing Nonmedical Services and Care Coordination Needs for Older Adults

“…To address this communication chasm, CBO respondents suggested that fundamental transformations in philosophy were necessary among both medical practitioners and policymakers in recognizing the importance of addressing the non-medical needs of older adults, and a will to devote resources accordingly. To achieve this critical paradigmatic shift, administrative efforts to routinize inter-organizational case conferences, and thus engender a collaborative mindset across entities (Reuther et al, 2012; Stott & Quinn, 2017; Weppner et al, 2018), could be especially valuable.…”