Impact of Patient Aligned Care Team Interprofessional Care Updates on Metabolic Parameters

A care plan is developed by the group to implement as appropriate. The care plan may consist of various recommendations from the different disciplines, such as consults to a pharmacist for medication review or medication management, referrals to social work to coordinate care with home health services, or asking the nurse care manager to follow up with a patient by phone on a more regular basis. Trainees are encouraged to use alternate forms of care, including team-based care from other health care disciplines as well as other methods of communication, such as secure electronic messaging to increase access.

Interprofessional patient case conferences could offer another tool for HCPs to improve the care of high-risk patients through team-based efforts if the effect on patient outcomes or health care use is beneficial. The objective of this study was to evaluate the relationship of interprofessional case conferences and A_1c levels in high-risk patients with DM and BP measurements in patients with hypertension whose case was discussed at PACT ICU case conferences at the Boise VAMC. The authors hypothesized that the PACT ICU presentation intervention would lead to improved metabolic parameters as care plans were implemented. This evaluation is a subset of a larger study assessing the impact of PACT ICU presentation on various patient, trainee, and team level outcomes.

Methods

This study was a retrospective, observational analysis of patients seen at the Boise VAMC academic clinic whose cases were discussed at PACT ICU case conferences from January 2013 to April 2014. For the analysis of A_1c values, patients must have been discussed at a PACT ICU presentation during the study time period and had a diagnosis of DM in the EHR. Those included must have A_1c results in the EHR before and after the patient case presentation. The most recent A_1c measured prior to presentation was chosen as the prepresentation value. The next measured value 2 to 6 months after the case presentation date was chosen as the postpresentation value. This was chosen as the postpresentation value because it may be more indicative of the impact of the PACT ICU care plan. An A_1c measured at least 2 months following the case conference intervention was chosen to allow all possible measurements to be included in the analysis, according to usual care for measuring A_1c at the clinic. The primary outcome was the mean change in A_1c values pre- and post-PACT ICU presentation.

Blood pressure analyses were included if patients had a diagnosis of hypertension in the EHR as well as recorded BP values measured during the 6 months prior to PACT ICU presentation and 1 to 6 months after presentation. Blood pressure values were limited to 1 to 6 months after presentation to be more suggestive of the case conference care plan impact. Blood pressure measured during hospitalizations, urgent care, or ED visits were excluded from the analysis. The primary outcome in the BP analysis was the mean change in systolic and diastolic BP pre- and post-PACT ICU presentation. The mean of all in-clinic BP measurements was calculated as the prepresentation value and compared with the mean of all postpresentation BP measurements in the designated time period.

Assessment of DM or hypertension control was not a factor for inclusion in the study. The types of interventions and recommendations resulting from the case conferences were not evaluated.

Results

During the study period, 65 patients were discussed at a PACT ICU case conferences (Figure). The average age was 67 years, and 89% of patients were male. Of these patients, 32 had a DM diagnosis. A total of 12 patients had A_1c values within the parameters specified for this study and were included in the final analysis for the A_1c group.

Of all patients discussed at a PACT ICU case conference, 52 had a diagnosis of hypertension (Table 2).