Balancing rigorous evaluation with clinical needs for an ambulatory intensive caring unit intervention

Central City Concern's Old Town Clinic is an integrated medical and behavioral healthcare clinic serving over 3,500 individuals experiencing homelessness or with very low incomes. A substantial subset of Old Town Clinic's population is highly medically complex and has concurrent behavioral health and psychosocial issues. The needs of this population were not adequately met by the existing team-based care model, and their complexity demanded disproportionate time and resource from care teams. In response, Old Town Clinic has developed an ambulatory intensive caring unit (AICU), which is an advanced primary care home designed to meet the unique needs of the clinic's most complex patients. Evaluating the effectiveness of a project like the AICU is essential but complicated. Conducting a rigorous assessment of the impact of the AICU requires a thoughtful evaluation design; the evaluation should rigorously measure the full breadth of the intervention while being in line with the goals and values of the clinical team.

The work of developing a new clinical care intervention can easily feel at odds with the rigid needs of formal research. Because they grow organically, new interventions like the AICU can be moving targets, which means the intervention today may not be the same as the intervention in six months. In this context of constant change, an important question arises: How can we conduct rigorous, meaningful research on an intervention that is constantly changing while accounting for the needs of the clinical team?

Our poster explores our solutions to the problem of balancing clinical care and research, which include: (1) integrating a quality improvement (QI) specialist into the care team, (2) reframing QI as an essential component of the research, (3) and adapting concepts from design-based research to bridge the gap between the demands of clinical care and needs of research. These solutions help us to connect theory and practice, allowing us to do more than simply describe our outcomes—we can describe why the intervention worked.