Redesigning inpatient care

Testing the effectiveness of an accountable care team model

Areeba Kara, Cynthia S. Johnson, Amy Nicley, Michael R. Niemeier, Siu Hui

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)773-779
Number of pages7
JournalJournal of Hospital Medicine
Volume10
Issue number12
DOIs
StatePublished - Dec 1 2015

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Patient Satisfaction
Inpatients
Diagnosis-Related Groups
Length of Stay
Safety
Costs and Cost Analysis
Quality of Health Care
Linear Models
Outcome Assessment (Health Care)
Delivery of Health Care
Health

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management

Cite this

Redesigning inpatient care : Testing the effectiveness of an accountable care team model. / Kara, Areeba; Johnson, Cynthia S.; Nicley, Amy; Niemeier, Michael R.; Hui, Siu.

In: Journal of Hospital Medicine, Vol. 10, No. 12, 01.12.2015, p. 773-779.

Research output: Contribution to journalArticle

Kara, Areeba ; Johnson, Cynthia S. ; Nicley, Amy ; Niemeier, Michael R. ; Hui, Siu. / Redesigning inpatient care : Testing the effectiveness of an accountable care team model. In: Journal of Hospital Medicine. 2015 ; Vol. 10, No. 12. pp. 773-779.
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