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Integrated Practice Unit Enhances Pediatric Aerodigestive Care

FRIDAY, June 26, 2020 -- Hospitals delivering care with an integrated practice unit (IPU) have improved clinical outcomes and lower costs of pediatric aerodigestive care, according to a study published in the July/August issue of NEJM Catalyst: Innovations in Care Delivery.

Chris Hartnick, M.D., from Harvard Medical School in Boston, and colleagues examined and compared the health outcomes and costs of pediatric aerodigestive care at six hospitals. Four of the hospitals delivered care with an IPU and two used traditional care delivery, with isolated specialists. Time-driven activity-based costing was used to measure and compare costs across the sites.

The researchers noted overall postoperative improvement in the Feeding/Swallowing Impact Survey, from an average of 1.8 preoperatively to 1.4 postoperatively in IPU sites. The non-IPU sites had average total physician times of 680 minutes compared with 701 minutes at the IPU sites; however, there was much higher use of lower-cost nursing time at non-IPU sites (average of 1,439 minutes versus 693 minutes at the IPU sites). The non-IPU sites had separate nursing teams for each physician rather than one nursing team working with an integrated physician team. The non-IPU sites had average total personnel costs 28 percent higher than the IPU sites ($4,284 versus $3,347).

"Providing aerodigestive care in the context of an IPU appears to be economically advantageous," the authors write. "In IPUs, the coordinated and integrated care was less expensive than it was in facilities offering notionally separate care."

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Posted: June 2020