Annals of Family Medicine Research

Collaboration Improves Patient Outcomes, Lowers Cost

September 04, 2019 03:05 pm Sheri Porter

Researchers at a private university in Nebraska found that they could improve patient outcomes and lower the cost of care in an ambulatory care center by implementing an interprofessional collaborative practice model.

[medical team illustration]

To test the model, they compared outcomes and costs attributed to 276 patients who were seen by members of a family medicine residency and faculty practice in 2016 -- before the ambulatory care center opened -- and again in 2017 during the center's first year of operation.

Details of the study can be found in an article(www.annfammed.org) titled "Innovations in Primary Care: Improved Outcomes Associated With Interprofessional Collaborative Practice." This brief research article is just one of more than a dozen offerings that comprise a special supplement(www.annfammed.org) to the July/August issue of the Annals of Family Medicine.

Corresponding author Thomas Guck, Ph.D., is a professor and director of behavioral health and vice chair of the Department of Family Medicine at Creighton University School of Medicine in Omaha, Neb.

Story Highlights
  • Researchers at Creighton University School of Medicine in Omaha, Neb., developed an interprofessional collaborative practice model and tested it in an ambulatory care center.
  • They compared outcomes and costs attributed to 276 patients seen by family medicine residents and members of a faculty practice before and after the care center opened.
  • Authors reported absolute reductions in ER visits, hospitalizations and hemoglobin A1c levels and attributed those improvements to use of the interprofessional model.  

"I am a psychologist with a long career in interprofessional education and collaborative care, originally working with an interdisciplinary chronic pain team," Guck told AAFP News.

He said the improved outcomes associated with creating and using the innovative practice model within the Creighton residency program should be of great interest to family physicians in practice.

"Health care is moving more and more to team-based care to achieve the quadruple aim of improving the health of populations, enhancing the patient experience of care, reducing the per capita cost of health, and improving the work life of health care clinicians and staff.

"Family physicians and other interprofessional providers are on the front lines of this health care challenge," he said.

Model Design

The authors noted that they used a "three-pronged approach" to build the interprofessional collaborative practice model that included staff and clinician training, patient care preparation and care conference planning.

They said their model "intentionally established a culture that encouraged collaborative care."

Grant-supported training sessions on conflict engagement were held before and after the ambulatory care centered opened.

The model included twice-daily huddles to allow the care team time to review safety issues, recognize team members, highlight care issues and share announcements.

The care team -- a resident, a nurse practitioner or faculty member, and a medical assistant -- worked together on previsit planning to discuss patient needs, and smaller groups along with individual professionals "collaborated on patient care continuously throughout the day."

The interprofessional team reviewed cases of patients from the high-risk registry were during weekly collaborative care conferences where recommendations for care were developed and added to the EHR's collaborative care documentation.

Annals Special Supplement Highlights Research Findings

In 2015, in an effort to move the United States closer to a value-based health care system, CMS launched the four-year, $700 million Transforming Clinical Practice Initiative, which involved more than 140,000 physicians and other health care professionals in all medical specialties.

Around the same time, an initiative from the Agency for Healthcare Research and Quality dubbed EvidenceNOW received $112 million in grants to help primary care physicians enhance the cardiac care of patients nationwide.

Fast forward to 2019, and the Annals of Family Medicine has published a special supplement(www.annfammed.org) to its July/August issue that reports early outcomes from both of these far-reaching projects.

Take some time to explore this research compilation, titled "Lessons from Practice Transformation," which includes seven original research articles, three special reports, three one-page innovations in primary care, two editorials and a research brief.

Key Findings

In 2016, researchers identified a group of high-risk patients who met one of three clinical criteria:

  • three or more ER visits in the first or second half of the year,
  • a hemoglobin A1c value of 9% or greater, or
  • a readmission risk status score of 10 or greater -- based on a LACE ranking derived from length of stay, acuity, comorbidities and ER visits.

After implementing the new model within the ambulatory care center in 2017, researchers saw absolute reductions of

  • 16.7% in ER visits,
  • 17.7% in hospitalizations and
  • 0.8% in hemoglobin A1c levels.

Additionally, total patient charges dropped by 48.2%, from $18,491 in 2016 to $9,572 in 2017.

Additional Author Comments

Guck said the interprofessional collaborative practice model shows that health care systems provide comprehensive education and quality care at the same time.

"We were able to train the next generation of health professionals -- including family medicine residents -- in how to work successfully in integrated teams while simultaneously achieving significant reductions in ER visits, hospitalizations, hemoglobin A1c levels and patient costs," said Guck.

Separate from the formal part of the study, Guck and his research team also noted a significant improvement in staff engagement and satisfaction, and a reduction in staff turnover.

Where will this work go next?

Guck said he and his colleagues will try to demonstrate the sustainability of the interprofessional education and collaborative practice model by continuing to follow the original cohort of patients and by "replicating these findings in new cohorts of higher-risk patients."