Outcomes of an integrated practice unit for vulnerable emergency department patients
Abstract Background An integrated practice unit (IPU) that provides a multidisciplinary approach to patient care, typically involving a primary care provider, registered nurse, social worker, and pharmacist has been shown to reduce healthcare utilization among high-cost super-utilizer (SU) patients...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-10067-9 |
| _version_ | 1797377148684599296 |
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| author | Deepa Borde Denny Fe G. Agana-Norman Robert Leverence Lorrie Photos Jon Shuster Kiran Lukose Jacqueline Pinkney Joy Wright Lori Waxenberg Brandon Allen Nila S. Radhakrishnan |
| author_facet | Deepa Borde Denny Fe G. Agana-Norman Robert Leverence Lorrie Photos Jon Shuster Kiran Lukose Jacqueline Pinkney Joy Wright Lori Waxenberg Brandon Allen Nila S. Radhakrishnan |
| author_sort | Deepa Borde |
| collection | DOAJ |
| description | Abstract Background An integrated practice unit (IPU) that provides a multidisciplinary approach to patient care, typically involving a primary care provider, registered nurse, social worker, and pharmacist has been shown to reduce healthcare utilization among high-cost super-utilizer (SU) patients or multi-visit patients (MVP). However, less is known about differences in the impact of these interventions on insured vs. uninsured SU patients and super high frequency SUs ( $$\ge$$ 8 ED visits per 6 months) vs. high frequency SUs (4–7 ED visits per 6 months). Methods We assessed the percent reduction in ED visits, ED cost, hospitalizations, hospital days, and hospitalization costs following implementation of an IPU for SUs located in an academic tertiary care facility. We compared outcomes for publicly insured with uninsured patients, and super high frequency SUs with high frequency SUs 6 months before vs. 6 months after enrollment in the IPU. Results There was an overall 25% reduction in hospitalizations (p < 0.001), and 23% reduction in hospital days (p = 0.0045), when comparing 6 months before vs. 6 months after enrollment in the program. There was a 26% reduction in average total direct hospitalization costs per patient (p = 0.002). Further analysis revealed a greater reduction in health care utilization for uninsured SU patients compared with publicly insured patients. The program reduced hospitalizations for super high frequency SUs. However, there was no statistically significant impact on overall health care utilization of super high frequency SUs when compared with high frequency SUs. Conclusions Our study supports existing evidence that dedicated IPUs for SUs can achieve significant reductions in acute care utilization, particularly for uninsured and high frequency SU patients. Trial Registration IRB201500212. Retrospectively registered. |
| first_indexed | 2024-03-08T19:48:34Z |
| format | Article |
| id | doaj.art-a6b52c1551a447079bcbce96ce9ed809 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-08T19:48:34Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-a6b52c1551a447079bcbce96ce9ed8092023-12-24T12:13:01ZengBMCBMC Health Services Research1472-69632023-12-012311710.1186/s12913-023-10067-9Outcomes of an integrated practice unit for vulnerable emergency department patientsDeepa Borde0Denny Fe G. Agana-Norman1Robert Leverence2Lorrie Photos3Jon Shuster4Kiran Lukose5Jacqueline Pinkney6Joy Wright7Lori Waxenberg8Brandon Allen9Nila S. Radhakrishnan10University of Florida College of MedicineUniversity of Texas Medical BranchUniversity of Texas HealthUniversity of Florida HealthUniversity of Florida HealthUniversity of Florida College of MedicineUniversity of Florida HealthUniversity of Florida HealthUniversity of Florida HealthUniversity of Florida College of MedicineUniversity of Florida College of MedicineAbstract Background An integrated practice unit (IPU) that provides a multidisciplinary approach to patient care, typically involving a primary care provider, registered nurse, social worker, and pharmacist has been shown to reduce healthcare utilization among high-cost super-utilizer (SU) patients or multi-visit patients (MVP). However, less is known about differences in the impact of these interventions on insured vs. uninsured SU patients and super high frequency SUs ( $$\ge$$ 8 ED visits per 6 months) vs. high frequency SUs (4–7 ED visits per 6 months). Methods We assessed the percent reduction in ED visits, ED cost, hospitalizations, hospital days, and hospitalization costs following implementation of an IPU for SUs located in an academic tertiary care facility. We compared outcomes for publicly insured with uninsured patients, and super high frequency SUs with high frequency SUs 6 months before vs. 6 months after enrollment in the IPU. Results There was an overall 25% reduction in hospitalizations (p < 0.001), and 23% reduction in hospital days (p = 0.0045), when comparing 6 months before vs. 6 months after enrollment in the program. There was a 26% reduction in average total direct hospitalization costs per patient (p = 0.002). Further analysis revealed a greater reduction in health care utilization for uninsured SU patients compared with publicly insured patients. The program reduced hospitalizations for super high frequency SUs. However, there was no statistically significant impact on overall health care utilization of super high frequency SUs when compared with high frequency SUs. Conclusions Our study supports existing evidence that dedicated IPUs for SUs can achieve significant reductions in acute care utilization, particularly for uninsured and high frequency SU patients. Trial Registration IRB201500212. Retrospectively registered.https://doi.org/10.1186/s12913-023-10067-9Super-utilizer patientsMulti-visit patientsInterdisciplinary careEmergency department visitsIntegrated practice unitHealthcare utilization |
| spellingShingle | Deepa Borde Denny Fe G. Agana-Norman Robert Leverence Lorrie Photos Jon Shuster Kiran Lukose Jacqueline Pinkney Joy Wright Lori Waxenberg Brandon Allen Nila S. Radhakrishnan Outcomes of an integrated practice unit for vulnerable emergency department patients BMC Health Services Research Super-utilizer patients Multi-visit patients Interdisciplinary care Emergency department visits Integrated practice unit Healthcare utilization |
| title | Outcomes of an integrated practice unit for vulnerable emergency department patients |
| title_full | Outcomes of an integrated practice unit for vulnerable emergency department patients |
| title_fullStr | Outcomes of an integrated practice unit for vulnerable emergency department patients |
| title_full_unstemmed | Outcomes of an integrated practice unit for vulnerable emergency department patients |
| title_short | Outcomes of an integrated practice unit for vulnerable emergency department patients |
| title_sort | outcomes of an integrated practice unit for vulnerable emergency department patients |
| topic | Super-utilizer patients Multi-visit patients Interdisciplinary care Emergency department visits Integrated practice unit Healthcare utilization |
| url | https://doi.org/10.1186/s12913-023-10067-9 |
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