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May 16, 2014

At UCMC, doctors offer long-term care

Researchers at the University of Chicago Medical Center (UCMC) are examining whether patients who receive medical care from the same doctor in both the clinic and the hospital experience better health outcomes than those that do not. The researchers believe that application of this method could reduce the cost of health care.

The study, called the Comprehensive Care Program (CCP), is funded by a $6.1-million grant from the Center for Medicaid and Medicare Innovation, a government organization created by the Affordable Care Act in 2010. The study focuses on Medicare patients who are frequently hospitalized and may experience the harmful effects of discontinuous care from their primary-care physicians in the clinic and hospitals. Hospitalists are in-patient physicians who provide referrals to specialists and communication with the primary-care physicians in the hospital.

The CCP models the style of health care used before the 1990s, when most primary-care physicians would treat patients in the clinic and hospital. However, as hospital admission rates for clinical patients started to decline, doctors stopped traveling to hospitals, according to David Meltzer, chief of the Section of Hospital Medicine, who came up with the idea for the CCP. Additionally, patients now tend to see their primary-care physician in better health, due to the development of preventive care innovations, which have decreased hospitalization rates. With these changes, hospitalists assumed the job of caring for patients, leading to the division of care in a clinical and hospital setting.

“[Hospitalists] ought to and generally do communicate with the primary-care physician about the events of the hospitalization, but sometimes that may not happen in an ideal fashion,” Gregory Ruhnke, assistant professor of medicine in the Section of Hospital Medicine, said. “So the primary-care physician might not know, for example, why [the hospitalist] changed Medicine X to Medicine Y.”

Ruhnke said continuous care could potentially provide better care for frequent hospital users, causing them to use the ER and the hospital less frequently.

In the study, Comprehensive Care doctors acted as both the primary-care physicians and hospitalists for their patients for only patients who are at a high risk of hospitalization. This allowed the doctors to develop deeper relationships with their patients that may translate into better care, according to Meltzer.

Doctors in the study spend their mornings seeing their patients in the hospital and their afternoons seeing patients in the outpatient clinic.

“Say things aren’t going well for the patient and it’s really time to think about end-of-life care rather than aggressive treatment,” Meltzer said. “Well, if I just met a patient, it’s going to be much harder for me to make that judgment and talk to the patient about that than it would be if I have a long-standing relationship with them and they know that I’m invested in them and want them to do well,” he added.

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