RT Journal Article
SR Electronic
T1 “It’s Like Riding Out the Chaos”: Caring for Socially Complex Patients in an Ambulatory Intensive Care Unit (A-ICU)
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 495
OP 501
DO 10.1370/afm.2464
VO 17
IS 6
A1 Chan, Brian
A1 Hulen, Elizabeth
A1 Edwards, Samuel
A1 Mitchell, Matthew
A1 Nicolaidis, Christina
A1 Saha, Somnath
YR 2019
UL http://www.annfammed.org/content/17/6/495.abstract
AB PURPOSE High-need high-cost (HNHC) patients consume a large proportion of health resources but often receive suboptimal care in traditional primary care. Intensive ambulatory care interventions attempt to better meet these patients’ needs, but we know little about how teams delivering these interventions in clinics serving socially complex patient populations perceive their work.METHODS We performed a qualitative study of multidisciplinary staff experiences at a Federally Qualified Health Center (FQHC) caring for predominantly homeless HNHC patients in the context of an ongoing implementation of an ambulatory intensive care unit (A-ICU) intervention. We conducted semistructured interviews with 9 ambulatory intensive care team members and 6 “usual care” members. We conducted a thematic analysis, using an inductive approach, at a semantic level.RESULTS Staff viewed complexity as a combination of social, behavioral, and medical challenges that lead to patient–health care system mismatch. Staff perceive the following as key ingredients in caring for HNHC patients: addressing both psychosocial and clinical needs together; persistence in staying connected to patients through chaotic periods; shared commitment and cohesion among interdisciplinary team members; and flexibility to tailor care to patients’ individual situations. Participants’ definitions of success focused more on improving patient engagement than reducing utilization or cost.CONCLUSION FQHC staff working with HNHC patients perceive mismatch between the health care system and patients’ clinical and social needs as the key driver of poor outcomes for these patients. Intensive ambulatory care teams may bridge mismatch through provision of psychosocial supports, flexible care delivery, and fostering team cohesion to support patient engagement.