“It’s Like Riding Out the Chaos”: Caring for Socially Complex Patients in an Ambulatory Intensive Care Unit (A-ICU)
Open Access
- 11 November 2019
- journal article
- research article
- Published by Annals of Family Medicine in Annals of Family Medicine
- Vol. 17 (6), 495-501
- https://doi.org/10.1370/afm.2464
Abstract
PURPOSE High-need high-cost (HNHC) patients consume a large proportion of health resources but often receive suboptimal care in traditional primary care. Intensive ambulatory care interventions attempt to better meet these patients’ needs, but we know little about how teams delivering these interventions in clinics serving socially complex patient populations perceive their work. METHODS We performed a qualitative study of multidisciplinary staff experiences at a Federally Qualified Health Center (FQHC) caring for predominantly homeless HNHC patients in the context of an ongoing implementation of an ambulatory intensive care unit (A-ICU) intervention. We conducted semistructured interviews with 9 ambulatory intensive care team members and 6 “usual care” members. We conducted a thematic analysis, using an inductive approach, at a semantic level. RESULTS Staff viewed complexity as a combination of social, behavioral, and medical challenges that lead to patient–health care system mismatch. Staff perceive the following as key ingredients in caring for HNHC patients: addressing both psychosocial and clinical needs together; persistence in staying connected to patients through chaotic periods; shared commitment and cohesion among interdisciplinary team members; and flexibility to tailor care to patients’ individual situations. Participants’ definitions of success focused more on improving patient engagement than reducing utilization or cost. CONCLUSION FQHC staff working with HNHC patients perceive mismatch between the health care system and patients’ clinical and social needs as the key driver of poor outcomes for these patients. Intensive ambulatory care teams may bridge mismatch through provision of psychosocial supports, flexible care delivery, and fostering team cohesion to support patient engagement.Keywords
This publication has 22 references indexed in Scilit:
- Primary care providers’ experiences caring for complex patients in primary care: a qualitative studyBMC Family Practice, 2016
- Interventions for improving outcomes in patients with multimorbidity in primary care and community settingsEmergencias, 2016
- Primary Care Physician Insights Into a Typology of the Complex Patient in Primary CareAnnals of Family Medicine, 2015
- Barriers and Facilitators to Managing Multiple Chronic ConditionsWestern Journal of Nursing Research, 2014
- Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practiceJournal of Clinical Epidemiology, 2012
- From Access to Engagement: Measuring Retention in Outpatient HIV Clinical CareAIDS Patient Care and STDs, 2010
- Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare BeneficiariesJama-Journal Of The American Medical Association, 2009
- Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and CostsJournal of General Internal Medicine, 2007
- Patient Complexity: More Than Comorbidity. The Vector Model of ComplexityJournal of General Internal Medicine, 2007
- Frustrating patientsJournal of General Internal Medicine, 1991