Institutional review board approval was obtained from University Hospitals Cleveland Medical Center for a retrospective study of 2 osteopathic community hospitals located in northeast Ohio.
The 2 hospitals were selected based on the presence or absence of ICCs. The hospitals in the study are part of the same hospital system with patient populations of similar socioeconomic status ($39,000-$43,000/year) and are both located in northeast Ohio. The hospitals’ primary care teams are staffed by the same residency training programs and medical students, with some faculty practicing at both locations. Both hospitals have the same ancillary staff available. The number of people without health insurance was less than 10% at each hospital and within 1% of each other. The percentage of bachelor-level college education at each township was within 10% of each other. The study consisted of men and women, aged 40 years and older, who were admitted for no less than 1 day for COPD exacerbations between January 2011 to December 2016 (
Figure 1). Race and ethnicity were not tracked in this study. The eligible study population was identified using specific International Classification of Diseases codes within the electronic medical record system: 491.1, 491.2, 491.21, 491.22, 492.21, 492.8, 493.2, 518.81, 770.2, J43.1, J43.2, J43.8, J43.96, J44, J44.1, J44.9, J68.4, J98.2, J98.3, P25.0, T79.7, and T81.82. Patients were excluded if they had any of the following known or suspected comorbid conditions: permanent tracheostomy, heart failure with significant left ventricular dysfunction, febrile temperature (>38°C), pregnancy, lactation, or severe mental illness.
Integrated care conferences were conducted by a nursing supervisor and typically took place 3 hours after morning rounds, with the nursing supervisor verifying that a representative from each health care provider team (ie, primary physician group, pharmacy, respiratory therapy, nutrition, physical and occupational therapy, social work, and case management) was in attendance. The ICC session took place in a quiet conference room with adequate space for all in attendance. The ICCs began with the nursing supervisor presenting the patient individually by his or her name and room number. The participating physician was then asked to provide the working diagnosis, treatments received, disposition, and potential barriers to discharge. Depending on the nature of the barriers to discharge, the nursing supervisor then engaged the appropriate team members in a brief but coordinated discussion to help facilitate a safe and timely discharge.
A 2-tailed
t test was used to determine whether there was a statistically significant difference in the average length of stay between the 2 groups. The patients were further age- and gender-matched to aid in controlling for comorbid factors common at different ages and genders. Ages were grouped by decade: 40, 50, 60, 70, 80, and 90 years. In one case, a patient older than 100 years was placed in the 90-year group. This addition did not alter the statistical significance or trends reported. A 2-tailed
t test for analysis of age and sex factors at and between each hospital was conducted. An analysis of variance (ANOVA) was used on the age groups. The Tukey test was performed on the ANOVA of combined age groups as well as at each hospital independently. A χ
2 test for trend was used to examine the length of stay between the 2 hospitals. All hospital stays longer than 10 days were put into a separate category (ie, 11+) for the χ
2 test because of the randomness of the length of stay after 10 days. All statistics were calculated with 95% CIs using Prism 7 (GraphPad), and a
P value <.05 was considered significant.