Many healthcare providers are finding that they work best as a coordinated, cohesive team, rather than individually in the traditional model.

For patients with complex or long-term conditions in particular, their care requires a host of experts to reach a successful outcome: perhaps a primary care physician, nurses, physical and occupational therapists, physician specialists, and home health aides, not to mention partners, children, friends, or neighbors.

When a team works together, quality and affordability are often improved. This team-based approach is becoming the norm in the United States, alongside growing popularity of accountable care organizations (ACOs). These organizations are groups of doctors, hospitals, and other healthcare providers that collaborate to share responsibility for their Medicare patients.

ACOs aim to improve healthcare quality and efficiency through clinical and financial integration. They oversee care from the clinic to rehabilitation to home for a defined population of patients. The group is responsible for both the quality and cost of that care. At present, ACOs take different forms depending on local market conditions and the existing competition among providers. The approach is outlined by the Centers for Medicare and Medicaid Services in the Medicare ACO Shared Savings Program, which proposes specific rules of conduct.

Medical Team

Pre-existing independent practice associations, which are groups of independent physician practices that work together in a health plan network, have an existing infrastructure that can serve as the basis for an ACO.

Caregiving teams that are guided by the patient and their family learn which aspects of the disease are most important to them and gain insights into the barriers to managing their condition that may be in place such as issues with transportation to clinic visits or difficulty with completing the necessary paperwork. Engaging patients and families acknowledges the importance of their unique perspectives and insights. Evidence suggests that when this happens, patients have better outcomes, the cost of care is lower, and healthcare professionals find their work more fulfilling.

Within hospitals, visiting hours could be extended, or nurses can get patients and family members more closely involved in ways such as carrying out shift change reports in the patient's room or sharing important information, including new or existing medications, discharge goals, and provider contact information.

Patients themselves can also get involved in creating more patient-centered systems and steering research toward questions that are important to them. This allows practitioners a better chance of developing solutions that will work in the real world.

Many research projects that have focused on collaborative working in health care are funded each year by the Patient-Centered Outcomes Research Institute. This Washington, DC-based organization was authorized by Congress in 2010 to "…improve the quality and relevance of evidence available to help patients, caregivers, clinicians, employers, insurers, and policy makers make informed health decisions".

One current project is the Rare Epilepsy Network, an attempt to build a patient/caregiver-centered database designed to collect information about rare epilepsy patients to better understand these conditions, improve treatments, and encourage research. It provides patients affected by a rare epilepsy and their families the opportunity to participate in studies by including patient- or caregiver-reported data related to medical history, diagnosis, and treatment, as well as patient and caregiver quality of life.

It will then "…address research questions and topics that are important to patients and caregivers with the ultimate goal of having them be better able to participate in healthcare decisions". The researchers state, "The advantage of intimate caregiver involvement is that we can also study the impact of the disorders on the health and well-being of the family." Furthermore, its steering committee includes researchers, clinicians, and caregivers.

A study on collaborative practice commissioned by the World Health Organization in 2010 states, "In the current environment of increasingly complex health care needs, there is a clear requirement for collaboration among health workers from different professional backgrounds as no one person is able to deliver care to meet the complete needs of the patient."

It concludes that collaborative practice has been shown "…to provide safe, timely and quality services with limited human and financial resources", but that it "…requires a strong political framework that encourages interprofessional education and teamworking."

References:

Centers for Medicare & Medicaid Services. Shared Savings Program.
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogram

Patient-Centered Outcomes Research Institute. Collaborative Patient-Centered Rare Epilepsy Network.
http://www.pcori.org/research-results/2015/collaborative-patient-centered-rare-epilepsy-network

Mickan S, Hoffman SJ, Nasmith L, et al. Collaborative practice in a global health context: Common themes from developed and developing countries. J Interprof Care 2010;24:492-502.
http://www.uea.ac.uk/cipp/collaborativepracticeinaglobalhealthcontext

One thought on “It Takes a Village to Heal a Patient

  1. In Healthcare it Take a Village – But What Kind of Village Will it Be?

    As the country’s healthcare providers increasingly form Accountable Care Organizations to share resources and responsibilities for treating Medicare patients, the Southern Medical Association says it takes a village to provide good healthcare, and that the ACO model is that village.

    It’s very true that healthcare delivery is a group effort. When a multidisciplinary approach is used to tackle problems of human health, patient outcomes will improve.

    But is this village the SMA describes just be for patients who are treated by large health systems, or will it be a diverse enough village to include patients who visit independent doctors? And will there be freedom of choice in this village, or will all the important decisions be dictated from above?

    If our healthcare system is going to be truly inclusive and democratic as we move to the ACO model, then the survival of independent doctors is more important today than ever before.
    Independent medical practices have been gradually vanishing because cost pressures and administrative and regulatory burdens. Many physicians find it easier to join a larger health network than to face these challenges with limited resources. The loss of these practices takes away healthcare access for many patients in underserved parts of the country, and reduces the number of treatment options in the overall healthcare system.

    Doctors who are part of managed care have been combining resources and sharing the responsibility of implementing Medicare programs, and networks of independent doctors are joining in this restructuring of healthcare delivery in America. But if these independent practitioners continue to close their doors, the number of patients who can benefit from the “village” of healthcare providers cited by SMA will get smaller. That’s not the direction we should be moving in.

    Additionally, if every doctor and healthcare administrator in the village is a part of the managed-care system, it means that every treatment decision for every patient will be–to some extent–dictated from a small group of people at the top. Managing healthcare for large populations of patients means there must be strict protocols for the delivery of healthcare.
    While these protocols are important, and while they are determined by dedicated healthcare providers, they can never guarantee the best treatment course for all patients all of the time. There is no “one-size-fits-all” in healthcare.

    Independent doctors and medical clinics represent more choice, and they represent independent treatment decisions.

    Many patients in America live in areas that are not adequately covered by the larger health systems, including inner cities and rural areas. Under the current ACO model, too many of these patients will be left out of the village.

    And too many of the patients who are included in the village will have important treatment decisions dictated by policies that were not written by their own doctor, but by the leaders of the village. These leaders have the best intentions, but they are removed from the day-to-day diagnosis and treatment of individual patients.

    This is just one more reason why America cannot lose its independent doctors. We should be building products that will not only help these doctors flourish, but will connect them to the larger health systems and government agencies that are crucial in healthcare delivery.

    The survival of independent medical practices is the key to making sure the village includes everyone, and that doctors and patients truly will have freedom of choice.

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