Acute Complex Care Model: An organizational approach for the medical care of hospitalized acute complex patients

Pietrantonio, Filomena; Orlandini, Francesco; Moriconi, L; Regina, Micaela La

doi:10.1016/j.ejim.2015.08.011

Cited by 19 publications

(17 citation statements)

References 32 publications

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“…The level of care should be adequate to acuity and complexity of the clinical picture; there should be more space for acute medical patients and the number of nursing staff should be proportioned to the patient On the basis of daily medical practice that registers a constant increase in poly-pathological complex patients, who require hospitalization for clinical instability in case of acute diseases and whose care is fragmented in multiple specialized interventions with movements from one ward to another, a very recent new model for the hospital management of acute complex patients was presented, called acute complex care model (ACCM). 23 ACCM represents an organizational approach tailored to acute complex, poly-pathological patients who are at high risk of inappropriate admissions or exaggerated resource consumption, in the absence of the multi-professional coordination and risk-benefit assessment of care that only an internist can provide.…”

Section: Role Of Internal Medicine In the Future Hospitalmentioning

confidence: 99%

Internal Medicine and emergency admissions: from a national Hospital Discharge Records (SDO) study to a regional analysis

2016

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In Italy, the number of internists has grown by 10% since 1990 reaching 11,435 units, they manage 39,000 beds in 1060 Internal Medicine (IM) wards. The Internists are expected to ensure a cost-effective management of poly-pathological and complex patients. A collaborative study between the Federation of Associations of Hospital Doctors on Internal Medicine (FADOI) and the Consortium for Applied Health Economics Research (C.R.E.A. Sanità) based on data from hospital discharge records has been conducted starting from November 2014. In this article the preliminary results are shown with focus on emergency admissions characteristics to contribute to define the role of hospital IM. Evaluation is performed comparing emergency and planned admissions, IM impact on hospital admissions, availability of community-based healthcare services, diagnosis-related groups (DRGs) weight in IM and regional differences in managing hospital admissions with focus on IM department. In 2013 IM wards discharged 1,073,526 patients (16.18% of the total discharged by hospitals) with a total economic value of 3,426,279.88 € (average DRG 3882.80 €, from 3682.19 to 4083.42). The average length of stay (LOS) in IM was 9.3 days. IM covers 27% of admissions from Emergency Room. Determinants significantly affecting the emergency admissions are old age and comorbidities of the patients that also have a role in increasing LOS. 55% of Italian hospital admissions are emergency admissions. Hospitalization rates in emergency are systematically higher than those in election and the greatest differences are in the regions with inefficiently organized regional network. The role of the hospital IM appears central in the offer of beds to the emergency room by accepting 27% of urgent admissions. The increasing impact of IM on hospital management will put the internists as authoritative stakeholders in health policy.

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Section: Role Of Internal Medicine In the Future Hospitalmentioning

confidence: 99%

Internal Medicine and emergency admissions: from a national Hospital Discharge Records (SDO) study to a regional analysis

2016

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“…Alternative outpatients' pathways must be searched for, in order to enhance appropriateness of care, to avoid overcrowding of emergency and medical wards, and to reduce clinical risk. 3 The distinctive features of this promising organizational approach are the following: i) proper selection of patients requiring hospitalization (risk/benefit ratio); ii) care pathways focused on patients; iii) global approach to patients; iv) problem solving and list of priorities; v) coordinated and integrated multi-disciplinary caring team; vi) appropriate use of resources (high technology, personnel, other equipment); vii) movements through different care settings depending on care needs and not on specializations; viii) reliable and comprehensive information system for clinical data sharing.…”

Section: The Distinctive Features Of Acute Complex Care Modelmentioning

confidence: 99%

“…The caring internist -the consultant -should be present every day -from admission to discharge -to ensure the continuity of care, to avoid handover errors and to warrant effective interaction with the specialists and better communication with patient and family. 3,7 ACCM attributes are displayed in Table 2.…”

Section: The Distinctive Features Of Acute Complex Care Modelmentioning

confidence: 99%

“…The internist in charge will write a clinical summary, the list of priorities and the composition of the multidisciplinary team, immediately after the admission. 3,8 Problem solving and extensive use of information system allowing quick data networking are the base for specialists' integration. Actually, problem solving is the process by which: i) the case is analyzed on the base of clinical experience; ii) knowledge and information provided by acquired data and interaction between specialists are integrated; iii) the solution of the problem is reached as quickly and efficiently as possible.…”

Section: The Distinctive Features Of Acute Complex Care Modelmentioning

confidence: 99%

“…frail patients when they need acute hospital care. 3 Nowadays, multiple uncoordinated specialists care for them who move from one ward to another, with dangerous loss of information and continuity. ACCM tries to overcome these problems by putting the internal medicine specialist as the only referent for that patient and the coordinator of the care team.…”

Section: Introductionmentioning

confidence: 99%

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A model to improve the appropriateness in the management of acute poly-pathological patients: the acute complex care model

Orlandini¹,

Pietrantonio²,

Moriconi

et al. 2016

Ital J Med

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Improved care for acute diseases has increased mean age and the proportion of people affected by multiple chronic diseases, while mutated socioeconomic conditions augmented the number of elderly and socially frail subjects. Multi-morbid patients who require a global approach not fragmented care interventions and a close connection between health and social services are progressively growing. Acute complex care model (ACCM) is a model of integrated management of the frail patients when they need of acute hospital care. The name of our model - ACCM - just recalls the Chronic Care Model (CCM), designed for the dehospitalization of chronic patients by preventing acute exacerbations, representing the hospital counterpart of the CCM. The target population are acutely ill complex and polypathological patients (AICPPs), admitted to hospital and requiring high technological resources and continuous monitoring; the mission is improving the management of medical admissions through pre-defined intra-hospital tracks and a global, multidisciplinary, patientcentred approach. Nowadays, multiple uncoordinated specialists care for AICPPs who move from one ward to another, with dangerous loss of information and continuity. ACCM tries to overcome these problems by putting the internal medicine specialist as the only referent for that patient and the coordinator of the care team. According to a model of future hospital organized with different intensity settings, the Internal Medicine Wards (IMWs), caring for AICPPS, are organized in High Dependency Areas and Ordinary Areas. For both we present organizational and personnel standards that are lacking in daily practice. The epidemiological transition leading to a progressive increase in AICPPs requiring frequent hospitalization enhances the role of hospital internal medicine specialist in the coordination and delivery of care. The ACCM represents a practical response to this epochal change of roles. Medical and nursing staff standards and competencies has to be reviewed to ensure adequate care for these patients.

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Modelling Hospital Medical Wards to Address Patient Complexity: A Case-Based Simulation-Optimization Approach

Landa

Regina²,

Tànfani

et al. 2020

Springer Proceedings in Mathematics &Amp; Statistics

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In this paper we focus on patient flows inside Internal Medicine Departments, with the aim of supporting new organizational models taking into account the patient relevant characteristics such as complexity and frailty. The main contribution of this paper is to develop a Discrete Event Simulation model to describe in detail the pathways of complex patients through medical hospital wards. The model has been applied to reproduce a case study of an Italian middle size hospital. The objective is quantifying the impact on resource use and outcome of introducing a new organizational model for medical departments. The reorganization is mainly focused on changing the available beds assignment among the wards to better address the complexity of care of patients with comorbidities. Following a patient-centered approach, patients are segmented considering the clinical characteristics (i.e. the pathology, proxy of Diagnoses Related Groups classification) and sub-grouped considering other characteristics, such as comorbidities and ward of admission. Then, an optimization component embedded into the model chooses the best pooling strategy to reorganize medical wards, determining the corresponding number of beds able to improve process indicators, such as length of stay. The simulation model is presented, and preliminary results are analyzed and discussed.

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Acute Complex Care Model: An organizational approach for the medical care of hospitalized acute complex patients

Cited by 19 publications

References 32 publications

Internal Medicine and emergency admissions: from a national Hospital Discharge Records (SDO) study to a regional analysis

Internal Medicine and emergency admissions: from a national Hospital Discharge Records (SDO) study to a regional analysis

A model to improve the appropriateness in the management of acute poly-pathological patients: the acute complex care model

Modelling Hospital Medical Wards to Address Patient Complexity: A Case-Based Simulation-Optimization Approach

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