Improved Outcomes with Diabetic Patients Using Integrated Practice Units

By Andy Smith | AAPL
April 29, 2018

A hospital CMO begins a pilot on a suggestion from a nurse practitioner and achieves better A1C measures and cost savings. 

Anne VanGarsse, MD, FAAP, CHCEF, tells the story of a part-time nurse practitioner who was reading about integrated practice units and thought it might be a good idea to try on the diabetic patients at Health Partnership Clinic near Kansas City, Kansas, when VanGarsse was the facility's chief medical officer.

Integrated practice units are models wherein specific types of patients are cared for by a clinical team that is dedicated, for example, to breast or headache-and-pain conditions and are a trending alternative solution to the frustrations that come with fragmented medicine.


Anne VanGarsse, MD, FAAP, CHCEF, discusses the concept of applying IPUs to select diabetic patients during her peer presentation at April's Physician Leadership Summit in Boston. | AAPL

In this case, VanGarsse was interested in applying the concept to diabetic patients. She discussed it in April during her peer presentation at the 2018 American Association for Physician Leadership's Physician Leadership Summit in Boston, Massachusetts.

As a federally qualified health center, the Health Partnership Clinic is required to achieve certain hemoglobin A1C measurements for its diabetic patients. “As with a lot of FQHCs, our measurements could use some improvements,” VanGarsse admitted.

That’s when a nurse practitioner approached VanGarsse and said, “Hey, what if we use this model of care for diabetic patients? What if we see only diabetic patients in the day of clinic – and see if those patients get better, have more improvement in their laboratory results than our other diabetic patients?”

“OK,” VarGarsse said. “Let’s try it.”

A clinical team consisting of the nurse practitioner, a diabetic nurse educator, a behavioral health consultant and an MA was assembled, and a pilot was launched, with the team seeing only already-diagnosed diabetic patients for a half-day each week.

“We followed those patients for four months to see how their outcomes were, and then we compared them at the end to how her normal diabetic patients who were sprinkled throughout her schedule the rest of the week did," said VanGarsse, now the associate dean of clinical affairs and population health for California Health Sciences University's College of Osteopathic Medicine, located in suburban Fresno.

"At the end of four months, [the team’s] diabetic patients who were on just that week – just that one day – definitely had a significant improvement in the hemoglobin A1C compared to the diabetic patients that were sprinkled throughout the rest of the week," she said.

“More significantly, they also had a higher frequency of having their diabetic foot exam documented, and having their diabetic retinal exam – not only a referral put in but then the actual documentation of visit from the ophthalmologist documented – like a three-fold increase in both of those two measures.”

The beauty of the integrated practice unit is that it allows the clinicians to focus on a single condition, VanGarrse said.

“They’re only thinking about doing one thing, so everyone kind of gets rolling. And so then they just do the same thing for every patient. And through that economy of scale you end up getting improved quality measures,” she said.

The short-term downside, VanGarsse said, is the expense of pulling a diabetic nurse practitioner and a behavioral health consultant out of the general circulation.

“But over time,” she said, “it turns out to be cheaper. We just haven’t been able to get to that point of measuring that yet.”

That will change. In the meantime, she said, diabetic patients at the facility are getting better care.

Andy Smith is a senior editor for the American Association for Physician Leadership. 


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