Valuing the Doctor-Patient Relationship

U of C brings back traditional care for select group of at-risk patients By Elizabeth Sidney

Many people believe the relationship between patients and their doctors is critical to better health. And a study at the University of Chicago Medicine is seeking hard data to show that greater coordination and continuity improves care and lowers costs for frequently hospitalized patients.

Thanks to a $6.1 million Center for Medicare and Medicaid Innovation award, the U of C is evaluating a comprehensive care physician (CCP) model with roots in traditional medicine.

The ongoing study assigns patients to one of two groups. Those treated under the CCP model see the same doctor in both the hospital and the clinic, and even at home, during house calls, lead researcher David Meltzer, MD, PhD, reports.

Patients in the other group have the choice of keeping their current doctor or changing to a different physician. If hospitalized, such patients are assigned a hospital doctor.

Discontinuity Hurts Patients

It’s abundantly clear from multiple studies that, “Complex, frequently hospitalized patients are hurt the most by discontinuity,” Dr. Meltzer notes.

And he is optimistic that the CCP model will lower costs if the team targets patients at high risk of hospitalization. And keeps them out of the hospital.

For both groups, investigators review patients’ medical records and call them every three months to learn about their health and the quality of care they receive.

The U of C recruited approximately 840 participants.

Patients’ greatest needs are not always medical. The CCP model therefore addresses practical problems, such as transport to appointments, help with understanding discharge instructions, or installing a lift and mechanized chair in the home.

Patients Able to Choose Doctors

The CCP model stratifies patients by expected hospital use. Frequently hospitalized patients and those at high risk benefit from having the same physician in both settings; all hospitalized patients get care from doctors with significant hospital experience. Finally, the CCP model can work for physicians, Dr. Meltzer states.

But sufficient numbers of patients must want to change doctors, and physicians need to let their patients switch, for the model to work, he says.

Evidence of the study’s effectiveness is expected by 2016.

Dr. Meltzer, a professor and chief of hospital medicine, also holds a doctorate in economics. His interest in health and public policy focuses on the theoretical foundations of medical cost-effectiveness analysis. He believes that over-specialization is a key factor in the nation’s out-of-control health care spending. One of Dr. Meltzer’s research goals is to identify optimal levels of specialization.