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.
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."
Centers for Medicare & Medicaid Services. Shared Savings Program.
Patient-Centered Outcomes Research Institute. 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.