Comprehensive Care Learning Collaborative

Every Monday, 8:00 – 9:00 AM

With healthcare costs rapidly increasing and care becoming more and more fragmented—especially for those who are hospitalized— there is a pressing need for innovation in healthcare provision. The Comprehensive Care Learning Collaborative (CCLC) serves as a forum to discuss the care of patients at increased risk of hospitalization. Multiple strategies and care models for this patient population will be discussed, including the University of Chicago’s Comprehensive Care Program (CCP) as our series’ nexus. The CCP enrolls patients at increased risk of hospitalization who then receive both inpatient and outpatient care from a single physician, a CCP, with the goal of improving care and health outcomes and lowering costs. The program began in January 2013 as a randomized controlled trial (RCT) that has enrolled over 2300 patients to date. Initial results from the RCT indicate the potential for substantial reductions in total health care costs and significant improvements in patient satisfaction and mental health ratings. Our curriculum aims to improve patient care, assist with the progression toward TCPI milestones related to the identification and care of patients at high risk of hospitalization (e.g., milestone 9 on the Primary Care PAT 2.0), and prepare for the MIPS program Improvement Activity requirements. This series is open to primary care and hospitalist teams looking to change care at their home institutions in a systemic way.

Topics for Case-Based Learning and Discussion Include:

• Patient engagement
• De-escalating care
• Chronic pain and opiate use and treatment
• Behavioral Health Integration
• Unmet social needs
• Social isolation
• Integrating trainees
• Inter-professional teams
• Family role and dynamics