By Leslie Ridgeway

The common refrain about health care is that it’s a broken system. The Galaxy Health model, which debuted at Los Angeles County + USC Medical Center in 2012, demonstrated a favorable effect on both patients and medical residents, according to a UCLA/USC study published online Sept. 2 in the Journal of the American Medical Association (JAMA)’s Internal Medicine.

The goal of Galaxy Health was to substantially improve a medical residents’ clinic at LAC + USC and demonstrate to county officials how some intuitive and inexpensive interventions could dramatically improve patient care and the morale physician and staff. The project was funded primarily by a three-year, $750,000 grant from the UniHealth Foundation.

The Galaxy model established round-the-clock, seven-day-a-week access to physicians, urgent clinic appointments available within hours and coordinated care in the ambulatory environment. It was based in part on increasing interest in the patient-centered medical home, which provides a team-based, coordinated approach to care aimed at making the primary care team central to the patient’s health needs.

“My hope was that Galaxy would reveal that a minimal investment and reorientation in delivery focused on the patient and enhanced access to care could improve the satisfaction of patients, staff and physicians, even in an underfunded public environment,” said David Goldstein, MD, associate professor of clinical medicine at the Keck School of Medicine of USC and chief of the division of geriatric, hospital, palliative and general internal medicine at LAC+USC Medical Center, who conceived the Galaxy Health program and was a senior author on the study.

The researchers conducted their study at three primary care internal medicine clinics at LAC+USC. They focused on expanded access to care, enhanced care coordination and team-based care. Galaxy Health included creation of a call center staffed by two care coordinators, telephone renewal of prescriptions, and up to five urgent care appointments available each day.

Input from patients and staff during prior focus groups was incorporated into the study. The researchers surveyed patients and residents before the intervention and again one year later. They also analyzed emergency room and hospital visit rates.

Though the clinics did not pass all the elements needed to qualify as a patient-centered medical home, overall their score jumped from a previous 35 points to 53 out of 100 possible points. The satisfaction rating from patients increased from 48 percent to 65 percent in the intervention clinic compared with a jump from 50 percent to 59 percent in the controls. Patients were particularly pleased with access. Satisfaction with urgent appointment scheduling increased from 12 percent to 53 percent in the intervention clinic vs. 14 percent to 18 percent in the control clinic.

The study findings support further investment in primary care, particularly in teaching settings where the next generation of primary care leaders will be developed, said Michael Hochman, MD, the study’s lead author, who conducted the research as a Robert Wood Johnson Clinical Scholar at the David Geffen School of Medicine at UCLA’s division of general internal medicine and health services research.

The composite satisfaction score for residents went up from 39 percent to 51 percent in the intervention clinic, but fell in the control clinic from 46 percent to 42 percent.

“This was anticipated because we expanded access to care to an underserved patient population, and frequently this creates a spike in emergency and hospital room utilization,” said Arek Jibilian, MD, assistant professor of clinical medicine in the Keck School division of geriatric, hospital, palliative and general internal medicine and a study co-author. “However, we believe that a sustained commitment to primary care will ultimately reduce this additional utilization.”

Grants from the Robert Wood Johnson Clinical Scholars Program, the U.S. Department of Veterans Affairs (grant 67799 to UCLA); the UCLA Resource Centers for Minority Aging Research Center for Health Improvement of Minority Elderly (RCMAR/CHIME) under NIH/NIA Grant P30-AG021684: and the NIH/NCATS UCLA CTSI (grant UL1TR000124) funded this study.