Implementing the patient care collaborative model in three general internal medicine units: a mixed-methods healthcare improvement initiative

• Main Authors: Elizabeth Barrett, Kelly LoPresti, Julianne Camera, Caroline Gosse, Donna Johnson, Gaya Amirthavasar, John Nashid, Mirabel Mbuagbaw, Thuvaraha Vanniyasingam
• Format: Article
• Language: English
• Published: BMJ Publishing Group 2020-06-01
• Series: BMJ Open Quality
• Online Access: https://bmjopenquality.bmj.com/content/9/2/e000815.full

Background As part of the scale-up of the Patient Care Collaborative (PCC) at our institution, we explored staff perceptions and patient outcomes at different levels of model implementation in three general internal medicine units.Methods We conducted a mixed-methods embedded experimental healthcare improvement initiative. In the qualitative strand, we conducted five focus group discussions. In the quantitative strand, we used hospital administrative data to compare outcomes (falls per 1000, median length of stay in days and resource use measured as resource intensity weights (RIW), before and after the implementation of the PCC, using χ2 tests, Wilcoxon’s rank sum tests and interrupted time series analyses.Results Staff showed considerable knowledge and acceptance of the PCC but expressed mixed feelings with regards to patient safety, workload, communication and teamwork. Staff perceptions varied by level of implementation of the PCC. A number of falls (overall) in the full implementation phase were not significantly different from the preimplementation phase (227 per 1000 vs 200 per 1000; p=0.449), but the number of moderate to severe falls dropped (12 vs 2 per 1000); p<0.001). Median length of stay (5 vs 6 days; p<0.001) and resource use were lower (0.1 vs 0.4; p<0.001) in the full implementation phase compared with the preimplementation phase. The trend analyses showed differences across units.Conclusions The PCC was moderately well adopted. Perceptions of the PCC among staff and patient outcomes are likely linked to the levels of implementation. The PCC resulted in improved safety, shorter hospital stays and lower costs of care.