Transitions in Health Care Delivery

Integrated practice unit (IPU) intricately combines a variety of

health care providers and support staff who assume responsibility for

specific diseases or clinical conditions, i.e., headache, epilepsy, or

diabetes (Porter & Lee, 2013). Michael Porter and Tom Lee illustrated

two critical features of IPU integrate patient-centered care that

provides evidence-based protocols, and the monitoring outcomes,

costs, and key metrics are utilized to encourage improvement (Porter &

Lee, 2013).

An application of an IPU concept such combining both pre-

hospital discharge and post-discharge transitional care into one with

the use of a virtual ward care model can decrease the chances of

readmission of patients who are already high-risk readmission (Low,

Tan, Ng, Tay, Ng, Balasubramanlam...Lee, 2017). The combination of

the two processes eliminates waste and maximizes resources. The

virtual ward model utilizes a predictive tool to identify patients who are

at high risk for readmission. It incorporates the systems, staffing, and

routines of the facility to offer multi-disciplinary case management to

these high-risk patients to decrease the risk of readmission (Lewis,

Moore, Doyle, Martin, Patton, Nugent, 2017).

Unfortunately, one of the biggest problems with our current

payment system is that it encourages volume-driven care versus

quality and value-driven care (Miller, 2009). The truth of the matter is
that providers, hospitals, and many others receive increased revenues

and profits if they increase the number of patients that are treated

(Miller, 2009). The need to see rising health care costs also fuel a

significant amount of patients. If the outcome is positive patient

experience, then the solution is to improve the value of without

increasing the costs or compromising patient outcomes, and or both

Porter & Lee, 2013).

Facilities to maintain adequate volume and deliver patient-

centered care, the virtual ward care model can restructure the facility

and work process to reduce readmissions (Lewis et al.). During the

discharge process, where patients receive their D/C planning:

medication reconciliation, education, individualized plan of care,

written instructions, appointments, and the virtual ward nurse contact

information. Applying the IPC concept to a virtual ward program is

assigned for these specific patients to ensure an efficient discharge

process to eliminate readmissions (Low et al.).

Singapore General Hospital, the largest tertiary hospital, applies

the virtual ward model. With a workforce of 10,000 and 1597 beds,

coming first among 51 countries, it is well known for its efficiency in

health care. Since 2006, Singapore has embraced a new way to

improve the quality of care and improve upon transitional care models

while they continue to maintain a substantial volume (Low et al.). With

such a large population of 5.6 M and a rapidly aging population, VW

has improved patient outcomes and significantly reduced hospital

sources. The overall implementation of the program suggested that the

model can be sustainable, and bundled payment is recommended to

provide a full payment cycle to withstand such applications (Low et

al.). The overall proposed goal of the IPU increases the value and

quality of healthcare with collaborative team members to maximize

the best patient outcome as efficiently as possible.

References:

Porter, M.E., & Lee, T.H. (2103). The strategy that will fix health care.

Harvard Business Review, 91(10), 50-70

Low, L. L., Tan, S. Y., Ng, M. J., Tay, W. Y., Ng, L. B., Balasubramaniam,

K., … Lee, K. H. (2017). Applying the Integrated Practice Unit

Concept to a Modified Virtual Ward Model of Care for Patients at

Highest Risk of Readmission: A Randomized Controlled Trial. PloS

one, 12(1), e0168757. doi:10.1371/journal.pone.0168757

Miller, H. (2009). From volume to value: better ways to pay for health

care. Retrieved from

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.5.1418

Lewis, C., Moore, Z., Doyle, F., Martin, A., Patton, D., & Nugent, L. E.
(2017). A community virtual ward model to support older persons
with complex health care and social care needs. Clinical
interventions in aging, 12, 985–993. doi:10.2147/CIA.S130876