“Right Size” hospitals as care transforms

Where have all the inpatients gone?” ask Robert York, Kenneth Kaufman and Mark Grube in this fascinating blog on the Health Affairs website examining shifts in inpatient admissions at Chicago hospitals. “Where have all the inpatients gone? A regional study with national implications” includes data from the fee-for-value Advocate system, where I am officially credentialed, affiliated as an outpatient provider through the  Chicago Family Health Center.

From 2010-2012, hospitalizations in Chicago are down for ambulatory care sensitive cases (ACSC). In other words, outpatient management of things like adult asthma and diabetes has prevented unnecessary hospitalizations for asthma exacerbations and uncontrolled diabetes.  I try my best to keep my patients out of the hospital.  It’s good to see that it might be working!

Chicago is projected to need  1900 fewer hospitalizations daily, as the focus of medical care shifts from inpatient sick care to outpatient health care.  The authors call this the transformation of the American medical system.

The Urban Health Initiative at the University of Chicago Medicine calls this the “right care, at the right time, at the right place.” We seek to provide cost-effective community care to patients through the affiliated practices of the South Side Healthcare Collaborative, keeping patients healthy, out of the emergency room, out of the hospital.

The authors of the study conclude: “This provides an early signal that the greater Chicago region, and by analogy many other regions in the nation, are likely not to need as many hospital beds or hospitals going forward. Such dramatic change would require the hospital industry to aggressively “right size,” while moving the focus of care away from the four walls of the hospital. The long-term implications of all of this are equal only to the boundaries of the reader’s imagination.”

What do you imagine may be the long-term implications of shifting the focus of care outside the  hospital?

2 thoughts on ““Right Size” hospitals as care transforms

  1. The answer to your final question depends entirely on how outpatient care is supported, paid for, and implemented. If robustly implemented, the outcomes could be wonderful for our whole society.

    As a psychiatrist, I have become used to seeing well-intentioned systemic changes become eroded and neglected over time. If outpatient general medical care follows the track that outpatient mental health care followed in the wake of the great emptying of our mental hospitals in the 60’s, we will be in a sad and sorry fix.

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