The Impact of Accountable Care Units on Patient Outcomes

Abstract

Background: Effective hospital teams can improve outcomes, yet, traditional hospital staffing, leadership, and rounding practices discourage effective teamwork and communication. Under the Accountable Care Unit model, physicians are assigned to units, team members conduct daily structured interdisciplinary bedside rounds, and physicians and nurses are jointly responsible for unit outcomes. Objectives: To evaluate the impact of ACUs on patient outcomes. Design: Retrospective, pre-post design with concurrent controls. Patients: 23,406 patients admitted to ACU and non-ACU medical wards at a large academic medical center between January 1, 2008 and December 31, 2012. Measures: In-hospital mortality and discharge to hospice, length of stay, 30-day readmission. Results: Patients admitted to ACUs were less likely to be discharged dead or to hospice (-1.8 percentage point decline [95% CI: -3.3, -0.3; p = .015]) ACUs did not reduce 30 day readmission rates or have a significant effect on length-of-stay. Conclusions: Results suggest ACUs improved patient outcomes. However, it is difficult to identify the impact of ACUs against a backdrop of low inpatient mortality and the development of a hospice unit during the study period.