乌鸦传媒

CHICAGO -- A new model of patient care designed to reduce rehospitalization in high-risk patients has dramatically increased patient satisfaction, a researcher said here.

In an ongoing randomized study, preliminary results show better comprehensive care for patients with end stage renal disease (ESRD) in addition to decreased healthcare costs, compared with usual care, according to , of the University of Chicago.

The model being studied centers on a group of five physicians with one core generalist in the center. The generalist is not limited exclusively to general internists, stated Meltzer during an oral presentation here at Kidney Week, the annual . For example, an endocrinologist or nephrologist could act as the generalist, due to his or her background in internal medicine.

Because most primary care physicians do not have enough patients in the hospital at any given moment, there is often no need for them to be at the hospital to visit patients. Instead, patients are handed off into a hospitalist's care.

Meltzer discussed the public health concern that comes with issues during transition of patient care among individuals who are at high-risk for re-admission, defined by spending 10 or more days in the hospital in one year. He reported on average, older patients with chronic conditions see approximately 16 separate healthcare providers in one year, in part due to increased specialist referrals. Due to this high volume of patient care transition, the researchers found a lack of communication between providers, resulting in increased rates of readmissions, medication errors, and unawareness of pending test results.

Past studies had found ESRD was a significant predictor of rehospitalization. In order to mitigate the risk that accompanies ESRD, Meltzer recommended a "Swiss cheese" model to patient care -- employing more strategies to prevent re-admission raises the probability of preventing it. Although this model has previously proven effective, according to past literature, the increases level of care comes at a high dollar cost.

The goal of the current study was to balance the costs associated with patient care and the benefits of the quality care. Meltzer et al. hypothesized they could achieve this by reducing the quantity of patient handoffs while increasing the quality.

In the study, they examined 2,000 high-risk patients, with 200 patients assigned to each physician. The interdisciplinary team included the patients' primary care providers. This was intended to allow better use of time in the hospital, avoiding redundant history-taking and testing.

One of the barriers to implementing the model, Meltzer said, is changing the way physicians structure their workday -- the way the model was designed, physicians needed to dedicate afternoons to visiting high-risk patients in the hospital.

Despite the upfront challenges the model poses, Meltzer stated the results have already shown that "just the savings in one patient in this could be enough to pay for the program, because it's that cheap and the expenditures are that high."

Not everyone was sold on the idea, however. During the presentation at Kidney Week, one audience member suggested legal difficulties in implementing this type of model in a hospital. Although the model is based around the PCP providing more comprehensive general care to the patient in order to reduce issues regarding poor patient handoffs, the audience commenter suggested he could be sued if, for example, he provided cardiac treatment to his patient.

In response, Meltzer argued a nephrologist could still provide general cardiac care. He highlighted the idea that many specialists trained in general internal medicine have lost the skills to be able to provide the most comprehensive general care to a patient, which subsequently has led to increasing rates of patient handoffs between doctors.

He added the "extraordinary degrees of patient satisfaction" suggests that a patient ultimately values the "continuity of care" this particular model can provide.

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