Effectiveness of Intensive Primary Care Interventions: A Systematic Review

Abstract

Intensive primary care interventions demonstrated varying effectiveness in reducing hospitalizations, and there was limited evidence that these interventions were associated with changes in mortality. While interventions could be grouped into categories, there was still substantial overlap between intervention approaches. Further work is needed to identify program features that may be associated with improved outcomes.

“It’s Like Riding Out the Chaos”: Caring for Socially Complex Patients in an Ambulatory Intensive Care Unit (A-ICU)

“…We found common characteristics seen in these models: adaptable teams that provide enhanced psychosocial supports for patients (through use of embedded nursing, social workers, etc as care team members), low patient-to-staff ratios with flexible schedules, and high-touch patient-centered approaches to care. [13][14][15] In addition, our findings suggest teams caring for HNHC patients may need to persist through the social chaos of patients' lives that often results in non-engagement with primary care, missed appointments, or failed transition plans, to build trusting relationships and achieve succcess. 9 Our finding that staff members value a sense of unity and esprit de corps speaks to the value of cohesive multidisciplinary teams doing this work.…”

“…Common features of A-ICUs include (1) decreased panel sizes of selected "high-risk" patients, (2) additional personnel for care coordination activities, and (3) appreciation of and integration with mental health and case management professionals to address psychosocial needs and streamline care. 13,14 While evidence is mixed on the efficacy of these models, 15 patients in A-ICUs perceive benefit from navigation of financial and social needs by these teams. 16 Studies to date, however, have not explored the inner workings of A-ICUs or the perspectives of multidisciplinary providers working in these care models.…”

Regarding “Effectiveness of Intensive Primary Care Interventions: A Systematic Review”

“…of our article, we incorrectly recorded the impact on hospitalization and length of stay from her 2015 study 1 as Bnot reported.^In fact, Dr. Ekdahl's 2015 study reported a nonsignificant reduction in hospitalizations (mean of 2.1 vs. 2.4 over 24 months, p = 0.212) and a reduction in average length of stay (mean of 11.1 days vs. 15.2 days over 24 months, p = 0.035). 2 Of note, in the results section of our review, we described the reduction in length of stay correctly.…”

Identifying Latent Subgroups of High-Risk Patients Using Risk Score Trajectories

“…To improve patient outcomes and reduce costs, healthcare systems have implemented care management programs, often with mixed results. 1,2 Typically, healthcare systems use risk stratification, or the process of categorizing patients by health risk status, to identify patients at high risk of adverse health outcomes. Then, they often apply the same intervention strategy to all patients identified as high risk.…”

“…Thus, it may be possible to identify longitudinal subgroups of high-risk patients who benefit from brief (e.g., transition in care or short-term services embedded within primary care) or long-term case (e.g., services embedded within primary care or dedicated primary care clinic for high-risk patients) management interventions. 1,5,6 Previous research has not examined heterogeneity among high-risk patients using trajectories of risk or comorbidity score, or the potential for group-based trajectories that could inform clinical decision making. Current approaches to identifying and stratifying high-risk patients primarily rely on crosssectional measurement of healthcare costs or comorbidity risk scores.…”