Patients who need frequent hospitalization account for a disproportionate amount of healthcare spending in the U.S. In 2012, the University of Chicago Medicine began enrolling patients in a clinical trial designed to test an imaginative way to reduce such hospital stays, and it may be onto something.
The study -- funded by a Health Care Innovation Award from the Center for Medicare and Medicaid Innovation, and featured in this weekend's New York Times Sunday Magazine -- was designed to determine whether doctors who focus their practices on the care of patients in and out of the hospital, known as comprehensive care physicians, could improve care while reducing hospitalization for a highly vulnerable set of patients at high risk for being hospitalized.
The core element of the CCP model is that the same physician provides care for patients in the clinic as well as in the hospital. A few even make house calls. The CCPs also lead a team of nurse practitioners, social workers, care coordinators and other specialists selected for their ability to address the needs of high-risk patients. Each physician carries a panel of about 200 patients at a time, serving as their primary care physician during clinic visits and supervising their care whenever they are hospitalized.
The model is built upon 15 years of research by study director David Meltzer, MD, professor of medicine at the University of Chicago and chief of hospital medicine, and colleagues, on the changing medical workforce in the U.S. The model was designed to provide better care at lower cost. In the pilot study, it was able to improve the continuity of patient care, especially during and after a hospital stay, as well as strengthen the bond between doctor and patient.
Half of the patients in the study were assigned to "standard care." They connected with a hospital-based primary care physician who saw patients as needed in the clinic, but did not directly take care of them if they were admitted to the hospital. The other half were assigned to one of five CCPs, who saw them during clinic visits and also cared for them in the hospital.
When the study was completed, it was evident that the CCP model was both preferred by patients and economically beneficial in terms of reducing healthcare utilization. Hospitalization rates for CCP patients were 15 to 22 percent lower than for standard care patients. They also gave their physicians higher ratings on the Hospital Consumer Assessment of Healthcare Providers and Systems, a patient satisfaction survey required for all hospitals by the Centers for Medicare and Medicaid Services.
The University's standard care physicians scored quite well, in the 80th percentile nationally, but the CCP doctors were in the 95th percentile. They also were ranked higher by patients dealing with mental health issues.
The trial is still underway. The next step is an expanded program, the Comprehensive Care, Community and Culture Program, designed to reduce the unmet social needs of economically and socially disadvantaged patients. About 400 people have already enrolled.
The approach is one of a few that have sprung up recently that attempt to address the issue of utilization. Earlier this year, a pilot study by investigators at Brigham and Women's Hospital suggested that, instead of being admitted and receiving care at a hospital, a patient could be cared for at home, and monitored using cutting-edge technology, resulting in decreased costs and utilization, as well as improved physical activity for patients.