Redesigning inpatient care: Testing the effectiveness of an accountable care team model

Abstract

BACKGROUND US healthcare underperforms on quality and safety metrics. Inpatient care constitutes an immense opportunity to intervene to improve care. OBJECTIVE Describe a model of inpatient care and measure its impact. DESIGN A quantitative assessment of the implementation of a new model of care. The graded implementation of the model allowed us to follow outcomes and measure their association with the dose of the implementation. SETTING AND PATIENTS Inpatient medical and surgical units in a large academic health center. INTERVENTION Eight interventions rooted in improving interprofessional collaboration (IPC), enabling data‐driven decisions, and providing leadership were implemented. MEASUREMENTS Outcome data from August 2012 to December 2013 were analyzed using generalized linear mixed models for associations with the implementation of the model. Length of stay (LOS) index, case‐mix index–adjusted variable direct costs (CMI‐adjusted VDC), 30‐day readmission rates, overall patient satisfaction scores, and provider satisfaction with the model were measured. RESULTS The implementation of the model was associated with decreases in LOS index (P < 0.0001) and CMI‐adjusted VDC (P = 0.0006). We did not detect improvements in readmission rates or patient satisfaction scores. Most providers (95.8%, n = 92) agreed that the model had improved the quality and safety of the care delivered. CONCLUSIONS Creating an environment and framework in which IPC is fostered, performance data are transparently available, and leadership is provided may improve value on both medical and surgical units. These interventions appear to be well accepted by front‐line staff. Readmission rates and patient satisfaction remain challenging. Journal of Hospital Medicine 2015;10:773–779. © 2015 Society of Hospital Medicine

Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems

“…During Implementation Phase II, interventions will be implemented on additional, phase II implementation units, leveraging lessons learned during phase I. Fidelity measurement and outcome data collection will continue for all study units. Our use of a phased approach during implementation is consistent with prior studies using similar interventions, [26, 28, 36] allows lessons learned in early implementation to be incorporated into later implementation efforts, and provides for a rigorous evaluation using both historic and concurrent controls (i.e., difference-in-differences analytic strategy).…”

“…The AIMS interventions address the challenges previously described and consist of 1) Unit-based Physician Teams, 2) Unit Nurse-Physician Co-leadership, 3) Enhanced Interprofessional Rounds, 4) Unit-level Performance Reports, and 5) Patient Engagement Activities. Our research team developed the AIMs interventions from available evidence, a detailed needs assessment, and our research team’s past experience implementing similar interventions [4, 26–28]. Each intervention is supported by specific processes and tools (Table 2).…”

The Impact of Accountable Care Units on Patient Outcomes

“…psychiatric care) and teams designed to address a specific quality issue (e.g., hospital acquired infections) [13,14]. A recent report on the implementation of an Accountable Care Teams model, which shares many of the features of ACUs, at Indiana University Health Methodist Hospital found that implementation was associated with reductions in length of stay and costs but did not affect readmission rates or patient satisfaction [15]. The assignment of hospitalists to units at Northwestern Memorial Hospital improved communication but did not increase physiciannurse agreement on patients' care plans [16].…”

Rethinking medical ward quality

“…59 60 Many ongoing ward initiatives share common themes: unit based teams, located with their patients; physician and nurse co-leadership; structured interdisciplinary rounds; and ward level performance feedback. [61][62][63][64] These act as useful "scaffolds," binding physicians, nurses, and allied health professionals together with collective accountability and a sense of belonging, even with fluid team membership. 65 Their impact remains uncertain, [66][67][68] and few high quality studies have reported whether they reduce adverse events or complications of care.…”