Cicle: Creating Incentives and Continuity Leading to Efficiency

1Johns Hopkins Bayview Medical Center, Baltimore, MD

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 28


The Joint Commission and Institute of Medicine have stressed that provider discontinuity of inpatient care poses many hazards to patient care. This fragmentation is thought to threaten patient safety and may influence length of stay (LOS), health care costs, and patient satisfaction. The impact of improved continuity of inpatient care is not known. Our objective was to determine the impact of a hospitalist‐developed continuity‐centered staffing model on hand‐offs, efficiency, and resource utilization. We hypothesized that the Creating Incentives and Continuity Leading to Efficiency (CICLE) model would result in desired outcomes.


Using a pre–post study design, we compared patient‐level data from the 6 months after the first month of implementation of the CICLE staffing model (September 2009–February 2010) to that from those same months in the prior year. Our study took place at a 335‐bed university affiliated medical center in Baltimore. All faculty hospitalists and midlevel providers participated in the study. Outcomes were measured using a population‐based convenience sample of 1743 and 1642 admissions during the pre‐ and post periods, respectively. Admissions that involved house staff were excluded. The number of unique hospitalists who billed a professional fee during hospitalization were used as a measure of continuity of care. Charges per admission and LOS assessed resource utilization, whereas readmission rates and payer‐denied days were reviewed to characterize quality.


Unique providers per admission declined by 13% under the CICLE model, from 2.09 to 1.81 (P < 0.0001). The LOS decreased by 16%, from 4.31 to 3.60 days (P < 0.0001). Mean total hospital charge per admission fell approximately 20%, from $9967.54 to $7999.27 (P < 0.0001), with significant savings in medications, laboratory charges, and radiology charges (all P < 0.001). All‐cause readmission rates at 7, 15, and 30 days and payer‐denied days were not affected (all P > 0.05).


The CICLE staffing model directly addresses the continuity problem in inpatient care. Furthermore, the CICLE model represents a viable cost‐saving and efficient model that is beneficial to all stakeholders in health care delivery.


S. Chandra ‐ none; E. E. Howell ‐ none; S. M. Wright ‐ Miller‐Coulson Family through the Johns Hopkins Center for Innovative Medicine, scholar/research support

To cite this abstract:

Chandra S, Howell E, Wright S. Cicle: Creating Incentives and Continuity Leading to Efficiency. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 28. Journal of Hospital Medicine. 2011; 6 (suppl 2). Accessed April 1, 2020.

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