PATIENT-CENTERED APPROACH TO HEALTH (PATH): OUTCOME ANALYSIS OF INTERDISCIPLINARY BEDSIDE ROUNDING

Padageshwar Sunkara, MD, MMCi, Dipendra Chaudhary, MD, FACP, FHM, Daniel Beekman, MD, FHM, Pradeep Yarra, MD, MPH, Parag Chevli, MD, FACP, Suma Menon, MBBS , Abhishek Dutta, MBBS, Hanumantha Jogu, MBBS, Tareq Islam, MD, MPH, Wake Forest School of Medicine, Lewisville, NC

Meeting: Hospital Medicine 2019, March 24-27, National Harbor, Md.

Abstract number: 187

Categories: Hospital Medicine 2019, Outcomes Research, Research

Keywords: , , , ,

Background: Interdisciplinary team-based care is a promising concept in hospital medicine in which healthcare team members representing multiple disciplines collaborate to develop patient care plans. Multiple published studies showed that team based care is associated with decreased length of stay (LOS).1,2Patient-Centered Approach to Health (PATH) team was a redesign of the Structured Interdisciplinary Bedside Rounding (SIBR) model originally started at Emory University by Stein et al.3

Methods: Teams consisted of a physician and/or advance practice provider (Physician Assistant or Nurse Practitioner), bedside nurse, pharmacist, care coordinator (Social Worker or Case Manager), bridge nurse navigator. The primary outcomes compared were LOS and 30-day all-cause readmission for control (NT) and intervention (AE) groups. Negative binomial and logistic regression were used to assess LOS and readmission respectively, adjusting for significant covariates.

Results: The intervention group had 1451 patient encounters while the control had 770 encounters. Demographic and co-morbid conditions of the intervention and control group were fairly similar in terms of demographic variables, with no significant differences in age, gender, race or ethnicity. The groups also had generally similar rates of comorbid conditions. Similar percentages of patients in the control group were admitted to the ICU during their stay (p=0.42).Overall mean LOS among the group did not show any statistically significant difference (7.2 and 7.1 days among intervention and control group respectively). When looking mean LOS by different strata of study population, only patients who were <65 years old, female, non-white and had 0-1 co-morbidities showed slightly lower mean LOS among intervention group compared to control group, but this difference was not statistically significant.
Analysis based on all study population, intervention group had 0.8 times less likely to be re-admitted within 30 days compared to control group. Patients 65 years old or older, female gender, white race and who had two or more total number of co-morbidities had statistically significant lower risk of being re-admitted in intervention group compared to control group. This association was strongest among age group 65 or older where intervention group had odds ratio of 0.66 (CI 0.46 – 0.94) compared to control group for 30-days readmission.

Conclusions: Interdisciplinary rounds improves patient outcomes and positively impacts care team dynamics in a setting of geographically positioned units. SIBR improved the quality of care by decreasing the 30-day-all-cause readmissions. For our patients SIBR led to an increase in LOS. The care team members found it to be an effective communication strategy to improve patient care. Future studies focusing on patient load per provider and patient and their family perception of interdisciplinary rounding might add further value.

To cite this abstract:

Sunkara, P; Chaudhary, D; Beekman, D; Yarra, P; Chevli, P; Menon, S; Dutta, A; Jogu, H; Islam, T. PATIENT-CENTERED APPROACH TO HEALTH (PATH): OUTCOME ANALYSIS OF INTERDISCIPLINARY BEDSIDE ROUNDING. Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, Md. Abstract 187. https://www.shmabstracts.com/abstract/patient-centered-approach-to-health-path-outcome-analysis-of-interdisciplinary-bedside-rounding/. Accessed November 15, 2019.

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