Collaborative care reduces health care costs and improves patient outcomes

Lowering costs and improving patient outcomes are common goals for most health care providers. A new study from Creighton University School of Medicine and Center for Interprofessional Practice, Education and Research, published Aug. 12 in the Annals of Family Medicine, yielded a reduction in health care costs in an especially vulnerable group: high risk patients.

The study, "Lessons From Practice Transformation," involved patients at a family practice clinic at CHI Creighton University Medical Center-University Campus near downtown. The clinic was specifically designed around something called the interprofessional collaborative practice (ICPC) model.

Our study demonstrated that interprofessional education and collaborative practice provided in a primary care residency-based program are associated with reductions of 16.7% in emergency room visits, 17.7% in hospitalizations, 0.8%in hemoglobin A1c levels, and 48.2% in total patient charges."

Thomas P Guck, PhD, psychologist and professor in Family Medicine, Creighton University, and lead author of the study

Guck said these results came about primarily because, "We are teaching future providers to work in teams," said Guck.

To get an idea of what that teamwork looks like, walk into the downtown area Creighton family practice clinic. There are patients checking in, some are sitting down waiting to be seen, nothing appears out of the ordinary. Behind the patient rooms is where the transformation begins. There's a medical assistant working on a computer next to a third-year family practice medical resident. A faculty physician is consulting with a nurse about a patient, right next to the social worker speaking with an occupational therapist. There's a pharmacy next to the waiting room, and ran occupational and physical therapy gym on the first floor. The patient has access to all of these services and clinicians in one place. It is known as the interprofessional collaborative practice (IPCP) model.

There are plenty of studies that show interprofessional collaborative care can lead to better, less costly outcomes in specific patient populations, like those with diabetes or heart disease, but until now no one has studied whether this model of care offers these same improvements in a diverse patient population like what you see in Family Practice. But the Creighton study showed a nearly 50% reduction in patient charges in one year.

"That's a cost savings of more than $4 million," said Joy Doll, OTD, occupational therapist, executive director of Creighton's Center for Interprofessional Practice, Education and Research (CIPER), and one of the study's authors.

Doll said those savings came about mostly because there were far fewer visits to the emergency room and patients were hospitalized less often.

This kind of change wasn't easy, for patients or clinic staff. An important part of the study, which was partly supported by grant funding, focused on team-building and training staff and clinicians how to productively engage in conflict. In other words, learning to respectfully admit to and talk about differing opinions, clashes, or struggles.

The study revealed an added bonus as well: a sharp drop in clinical burnout.

"Out of 151 clinics we used to be in the bottom 2/3 with regard to employee engagement, i.e. happy clinicians," said Doll. "Now we're first or second in that area (employee engagement), and retention at the clinic is really high."