Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Family Medicine
Teaching Rounds, Benchmarking, Hospitals
Purpose/Background: In 2016, Maine Medical Center (MMC) was awarded a grant to improve the clinical learning environment and quality of patient care. This led to the development of the Interprofessional Partnership to Advance Care and Education (iPACE) model which increases collaboration through structured communication amongst members of the health care team during daily bedside rounds. This allows the interprofessional team to work with the patient to create a shared care plan each day. Preliminary data shows that since its implementation, the iPACE service has trended towards decreased length of stay (LOS) and improved patient satisfaction compared with other adult inpatient medicine services at our hospital. The family medicine service adopted this model in April 2019. Our study assesses if the iPACE model has led to improvements in clinical hospital outcomes including length of stay (LOS), 30-day readmission rates, and patient complexity measures, on the family medicine service compared to the former “table rounding” model. This project will help to inform future rollouts of the iPACE model to other service lines and departments throughout MaineHealth.
Methods/Approach: We conducted a retrospective cohort study of adult inpatient medicine encounters at an academic medical center on the family medicine inpatient teaching service using a “table rounding” structure from April 8th through September 30th, 2018 (TR cohort) and after the implementation of iPACE from April 8th through September 30th, 2019 (iPACE cohort). We excluded patients in the iPACE cohort who were not located in the target unit of R4 or spent over 50% of their hospitalization outside of R4. We collected patient demographic information including age, gender and race. Data analysis compared the primary outcomes of average LOS, 30-day readmission rates, and case mix indices. Secondary outcomes included rates of mortality and alternative measures of patient complexity.
Results: There were 368 patients in the TR cohort and 165 in the iPACE cohort. Inpatient admission status was classified as observation or bedded outpatient for 62 and 18 hospitalizations, respectively. Demographics were similar in terms of gender (49-50% female) and race (94-96% white). Mean age was higher in the iPACE cohort (mean=65.6, SD=17.5) than the TR cohort (mean=61.7, SD=18.7) (p=0.02). There were no significant differences in average LOS between the TR (6.5 days, SD=7.8) and iPACE cohorts (7.8 days, SD=12.5; p=0.23). There were no significant differences in either the 30-day readmission rates or the rates of mortality, both of which were infrequent occurrences. The case mix indices were 1.7 (SD=2.1) and 1.9 (SD=2.1), respectively (p = 0.43). However, there were significantly more patients who received higher levels of care in the iPACE cohort (33.3%) than in the TR cohort (23.6%) (p=0.026).
Conclusions: The iPACE model of interdisciplinary rounding as implemented on R4 resulted in similar average LOS, 30-day readmission rates, and case mix indices. The family medicine service has benefited from the clinical and interprofessional advantages of iPACE without a deterioration of hospital outcomes.
Walker, Bryan; Miller, Alison; Haskins, Amy; and Holt, Christina, "Impact of internprofessional bedside rounding on clinical hospital methods hospital metrics" (2020). Costas T. Lambrew Research Retreat 2020. 51.