In Pierluissi's ACE unit, beds are near windows to orient patients to daylight. Patients eat meals with other patients in a communal area.
"We don't treat sleeping problems with a pill, we don't go overboard with pain medication, and we promote independence as much as we can by not doing things for patients they can do by themselves. And we really question the need for certain procedures, to make sure they are in line with the patients' goals for care," he says.
But ACE unit adoption has been slow because the fee-for-service system, Pierluissi says, "has been an impediment.
"If you're in the (healthcare) business, and people keep getting readmitted, cycling through nursing homes, that's all good. You keep charging for that stuff. But when people start looking at designs that keep patients out of the hospital, and keep folks from being admitted in the first place, they'll look for good models of care and they're going to land on ACE because the evidence is strong."
Kresevic and Pierluissi say ACE units are demanding. "The reason you don't see more of these is because it's a complicated intervention that requires a lot of teamwork and dedication over a long period of time. And it requires leadership commitment."
Kellie Flood, MD, is an author of the JAMA Internal Medicine paper that showed the University of Alabama at Birmingham Hospital's ACE unit saved $371 in direct costs per patient, totaling $148,000 for every 400 patients admitted to an ACE unit. That may not sound like much, but at least it's not a net cost. And the patients get better care, she says.