Empirical analysis of the impact of collaborative care in internal medicine: Applications to length of stay, readmissions, and discharge planning

Abstract

This paper presents original insights about the benefits of collaborative care in an internal medicine inpatient service at a Texas academic medical center. Collaborative care requires close and frequent coordination among all members of a patient care team - providers, case managers, social workers, specialists, and other clinical and professional staff. Hospitals and clinicians are concerned with whether the benefits accrued to patients and hospital operations outweigh the resource requirements imposed by this innovative integrated care approach. To investigate outcomes, the approach was implemented by one of its five teaching teams at the medical center hospital. Researchers then developed statistical models that suggested the effect of collaborative care on patient length of stay and discharge planning was favorable and statistically significant. Lasso and stepwise regression models were estimated that suggested a 9% decrease in expected length of stay –without increased readmissions – and an increased likelihood of being discharged before 2 pm to enable improved patient throughput and bed turnover. Additional patient survey data confirmed that patient satisfaction remained high for patients under the care of the collaborative care team. Discussions with hospitalists and nurses during and after implementation indicated that the new approach required a change in logistics and how patient care was performed. Our research suggests there is a corresponding ‘learning effect’ – the impact was more pronounced and significant once an attending physician had two or more separate rotations on the collaborative care team.