Headline
Multidisciplinary integrated practice units may have a greater impact on acute care utilization by focusing on patients who have high utilization of emergency departments and are uninsured.
Context
Individuals with multiple chronic conditions and social needs experience care fragmentation, which can lead to the frequent use of acute and costly care services. An integrated practice unit (IPU) is a type of team-based care that addresses individuals’ physical, mental, and social health needs and has been shown to reduce hospitalizations and overall costs for people with complex health and social needs. IPUs typically include a primary care provider, registered nurse, social worker, and pharmacist. This study examines the efficacy of IPUs on two different complex need patient subgroups: (1) insured vs. uninsured and; (2) patients with four to seven emergency department (ED) visits per months vs. patients with more than eight ED visits per month.
Findings
Using patient charts, comparing 186 complex need patients from six-months before and after enrollment in the IPU at a Florida tertiary care facility, the authors found that there were significant reductions in ED visits, hospitalizations, and hospital days. Uninsured patients had a greater reduction in stays and costs compared to those with Medicaid or Medicare coverage. These trends were also observed in patients with four to seven ED visits compared to patients with over eight visits. The differences between groups could not be accounted for based on behavioral health diagnoses, as both groups had similar prevalences of mental health and substance use disorders.
Takeaways
This study adds to evidence supporting IPUs in better serving individuals with chronic disease and social needs and offers potential evidence for targeting IPUs for individuals who are uninsured and who have high utilization of EDs.