As defined by Porter and Lee, “in an IPU (integrated practice unit), personnel not only provide treatment but also assume responsibility for engaging patients and their families in care…personnel work together regularly as a team toward a common goal: maximizing the patient’s overall outcomes as efficiently as possible. They are expert in the condition, know and trust one another, and coordinate easily to minimize wasted time and resources. They meet frequently, formally and informally, and review data on their own performance. Armed with those data, they work to improve care—by establishing new protocols and devising better or more efficient ways to engage patients, including group visits and virtual interactions. Ideally, IPU members are co-located, to facilitate communication, collaboration, and efficiency for patients, but they work as a team even if they’re based at different locations.”
The authors also describe important cost benefits of the IPU architecture: “Providers are achieving savings of 25% or more by tapping opportunities such as better capacity utilization, more-standardized processes, better matching of personnel skills to tasks, locating care in the most cost-effective type of facility, and many others… Numerous studies confirm that volume in a particular medical condition matters for value. Providers with significant experience in treating a given condition have better outcomes, and costs improve as well….there are huge value improvement opportunities in matching the complexity and skills needed with the resource intensity of the location, which will not only optimize cost but also increase staff utilization and productivity.”
Finally the authors describe how IPUs would scale nationally: “…a hub-and-spoke model. For each IPU, satellite facilities are established and staffed at least partly by clinicians and other personnel employed by the parent organization. In the most effective models, some clinicians rotate among locations, which helps staff members across all facilities feel they are part of the team. As expansion moves to an entirely new region, a new IPU hub is built or acquired.”
IT as a force multiplier in an IPU architecture
This is perhaps the key component of the transformational strategy…the ability to develop an interactive supporting information system that performs as a “force multiplier” in enhancing the performance of the IPU. The IPU IT system follows patients across services, sites, and time for the full cycle of care, including hospitalization, outpatient visits, testing, physical therapy, and other interventions. Care coordination is enabled by the common platform since data are aggregated around patients, not departments, units, or locations. In effect the IPU can be considered a “community of interest”, a term used by the DoD to define a collaborative group of users that exchange information in pursuit of its shared goals, interests, missions, or business processes using a shared vocabulary for the information it exchanges. In an IPU, ontologies, terminology and data fields related to chief complaints, diagnoses, lab values, treatments, and other aspects of care are standardized in proper context (the clinical domain of interest to the IPU like diabetes, cancer, etc.) so that everyone is speaking the same language, enabling data to be understood, exchanged, and queried across the whole system.
IPUs also represent a form of “horizontal integration”, another term used in the DoD that refers to the desired end-state where intelligence of all kinds flows rapidly and seamlessly to the warfighter, and enables information dominance warfare. In our case, data from the entire care continuum is made available for optimal decision-making at the point-of-care. My final blog post on this topic will expand on this concept of using data more productively in the healthcare setting.