Pilot Program at Oakland Hospital Cuts HIV/AIDS Readmissions Almost in Half

University of California researchers yesterday released initial results of a pilot project to launch a patient-centered medical home model of care for HIV/AIDS patients at a hospital and four community clinics in Alameda County. The early results were pretty striking, according to George Lemp, director of the California HIV/AIDS Research Program for the UC system. "It's very encouraging," Lemp said. "If we can reduce hospital readmission rates, we might be able to bring down some of the cost of medical care and improve outcomes."

According to Lemp, this particular patient population is an especially good candidate for implementing the patient-centered medical home because a high level of participation by patients is critical to the program's success. "We think the patient-centered medical home has merit to improve patient outcomes and improve the coordination of care, particularly with complicated conditions," Lemp said. "We don't see why this model can't apply to other complicated diseases. After all, these diseases are managed over a lifetime, whether it's diabetes or HIV." At Highland Hospital in 2010, about 39% of patients with HIV and AIDS needed to be readmitted within 30 days, Lemp said. That's now down to 22% within 30 days.

Four community clinics participated in the pilot program to bring down readmissions at Highland: Tri-City Health Center in Fremont, Lifelong Medical Care in Berkeley, La Clínica in Oakland and Asian Health Services in Oakland. But it's not all about readmissions, Lemp said: "Those community clinics are seeing the benefits of this on a daily basis," he said. "They have formed a team and a network of people to improve patient outcomes, along with the patient." There are a number of medical-home demonstration projects across the state that the UC system is helping fund, Lemp said.