University of Chicago Medicine proposes new care delivery model for patients at increased risk of hospitalization

May 7, 2014

Finding the most effective way to treat patients before, during and after hospitalization is a major challenge.

Up to about 20 years ago, most hospitalized patients received care in the hospital from their primary care doctor.

In recent years, patients admitted to the hospital have often had their care handed off from their primary care physician to a hospitalist, a physician whose job is to care for patients once they enter the hospital.

This exchange between hospital care and ambulatory care -- both at hospital admission and at discharge -- has often caused problems in coordinating care, leading to poorer medical outcomes and higher costs.

Both models have strengths: a primary care physician knows the history of the patient and already has personal relationship with them; a hospitalist, on the other hand, has greater expertise in navigating the complexities of hospital care.

Few studies, however, have pinpointed a clear winner, and various care coordination models have failed to reduce total costs.

In the May issue of Health Affairs journal, David Meltzer, MD, PhD, and chief of the Section of Hospital Medicine and Gregory Ruhnke, MD, assistant professor of medicine in the Section of Hospital Medicine at the University of Chicago Medicine, propose a hybrid.

In a paper entitled, Redesigning Care for Patients at Increased Hospitalization Risk: The Comprehensive Care Physician Model, the authors recommend a single physician provide care in both inpatient and outpatient settings, reducing the need for costly mechanisms to coordinate care and strengthening the doctor-patient relationship.

"However, the key difference between the CCP model and the traditional model is that the CCP model focuses on patients at high risk of hospitalization," the authors write. "Limiting patient panels in this way is intended to give CCPs enough hospitalized patients to have a meaningful daily physical presence in the hospital while still allowing them to provide ambulatory care for their patients."

For the patient, the continuity of care provided by a single physician decreases the chances of lapses in care.

The study also says that for the physician, "it is easier and often more psychologically rewarding for a doctor to care for a patient he or she already knows".

Despite the focus on having one physician care for the patient in both settings, the CCP program emphasizes the importance of a care team, with 5 physicians and other health professionals enabling efficient coverage and a sustainable work load on week days and weekends.

Implementation of the CCP model at the University of Chicago Medicine, which began in 2012, was funded through the Center for Medicare & Medicaid Innovation's Health Care Innovation Awards.

These awards, which began in 2011, were designed to foster new care delivery models with the three-part aim to create better health, better health care and lower costs.

Part of the award was also funding to study the effects of the CCP. Evidence on the effectiveness is expected by 2016.

Meltzer outlined the CCP at a Health Affairs briefing Wednesday, May 7, at the National Press Club in Washington, D.C.