IPOP: Inpatient/Outpatient Care Continuum
The Johns Hopkins Oncology Center has implemented a new method of delivering care to blood and bone marrow transplant (BMT) patients and their families. This new model of care delivery, IPOP (Inpatient/ Outpatient Care Continuum), has significant advantages for patients undergoing transplant. IPOP provides continuity of care throughout the BMT process, allows the patient to stay in a more home-like environment with his/her caregiver while receiving certain phases of care, and decreases the length of time spent as an inpatient.
IPOP is a patient-focused health care delivery model which maximizes opportunities in the ambulatory setting, minimizes the need for inpatient care, and ensures excellence of care and continuity of providers across the patient care continuum. IPOP includes intensive ambulatory support adjacent to the inpatient BMT units with 24 hour access to care, continuity of the health care team across the different locations for care, and residential living facilities.
Eligibility criteria include criteria related to diagnosis, type of transplant, pre-existing conditions, functional status, ability to communicate, and availability of care provider to stay with the patient. A preliminary screening for eligibility is included as part of our initial evaluation of a referral; however, a final decision will not be made until the patient and caregiver come to Baltimore for evaluation prior to transplant.
The IPOP critical pathway includes the same components as for inpatient care; the BMT process remains the same. If admitted to IPOP, patients come each day for care to the IPOP clinic and spend their nights in residential living facilities with their caregiver. For most patients the first two to three weeks of care will be delivered in this setting. Complications of BMT such as fevers, organ dysfunction, and graft-versus-host disease are examples of events that change the location of care from the IPOP clinic to the inpatient unit. As patients recover from these common BMT problems, they are able to move back to the IPOP clinic for care. The same primary medical and nursing team care for them whether they are on the BMT unit or in the IPOP clinic.
As a result of making these changes in our BMT program, our IPOP patients spend less than 10 days of their total stay in an inpatient bed. Patients and families benefit from the opportunity to remain an outpatient for much of their stay, and appreciate the enhanced continuity of care provided by this unique program.
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