| |
Is it your experience that patients and families can sometimes feel lost in our health care system? As a referring physician, do you sometimes feel removed from decisions being made on behalf of your patients?
"The inability to properly coordinate care has long plagued our health care system," says Richard A. Antonelli, MD, MS, medical director of the Children's Hospital Integrated Care Organization (CHICO). "To get it right and offer quality care that's both efficient and centered around the patient and family, we need to make some fundamental changes."
Specifically, as a result of CHICO's efforts, Children's Hospital Boston is moving to better integrate the care provided by primary care physicians and pediatric subspecialists and to ensure that care is organized around the child's and family's needs.
Children's is examining how care is provided within the hospital itself, by its hospital-based physicians and by referring primary care physicians. Through CHICO, the hospital and the Pediatric Physicians' Organization at Children's (PPOC) are also working to fully implement the Family-Centered Medical Home model across our network of 75 pediatric primary care practices.
According to Dr. Antonelli, the Medical Home model emphasizes the central role of teamwork and engagement of families in their own care "It's an empowerment model, building on the strengths of families, patients and their community," he says.
How is integrated care different from current care patterns? How does it improve care for individual patients and help families? Consider the following examples, which illustrate what CHICO is working to achieve:
-
A child comes into the Emergency Department (ED). Because the hospital and the child's primary care physician (PCP) have compatible electronic medical record systems, the attending physician in the ED is able to view the child's medical record, which includes the child's medications and a list of health problems. As soon as the child has been treated, information about the ED visit is sent to the PCP so the child can receive follow-up care the next day in his or her Medical Homeóthe primary care practice or pediatric subspecialty practice from which the child's care is being coordinated.
-
A child is admitted to the hospital. Upon admission, the inpatient care team confers with the child's PCP, who is informed about the details of the child's care in the hospital as well as any unresolved issues. In association with the inpatient care team and the child's PCP, the family contributes to the creation of a care plan that clearly defines the next steps in their child's diagnosis and treatment. The family receives a copy of the care plan when the child is discharged, and it's also available in the child's personal electronic health record.
-
A child is referred to a pediatric subspecialist. The consultation request form completed by the PCP documents the referral questions and provides supporting clinical data, including laboratory and imaging reports already ordered by the PCP. In conjunction with the family, the PCP and subspecialist select the appropriate care model from the following: the PCP as principal manager of the child's care, the PCP and subspecialist as co-managers, or the subspecialist as the primary manager of the child's care. This approach supports the PCP's ability to optimally manage the care of children requiring consultations in a community-based primary care setting. It also reduces duplicative and unnecessary testing and makes explicit the locus of responsibility for ordering follow-up tests.
At its core, integrated care is the seamless, coordinated provision of health care services, as seen from the patient's and family's perspective, across the entire care continuum. According to Dr. Antonelli, the characteristics of an integrated care system include:
-
A well-defined locus of responsibility for a patient's care at all points of contact throughout the system.
-
Well-defined mechanisms to engage and empower families as partners in their child's care. This component of integrated care treats patients and families as integral to and equal partners in the care process.
-
Information-sharing among all providers involved in a patient's care so that the right care is delivered at the right time in the most cost-effective location.
-
Shared accountability and transparency among all providers for patient outcomes, resource utilization and the cost of care.
-
Care coordination as an integral component. A key indicator of an integrated care organization is that, at any point in time, the family knows who is responsible for all activities enumerated in the care plan.
According to the National Committee on Quality Assurance, a practice qualifies for recognition as a Medical Home if it meets the following criteria: 1) improved access and communication; 2) patient tracking and registry, including the use of data systems to ensure safety and reliability; 3) care management and coordination; 4) patient self-management support; 5) electronic prescribing; 6) test tracking; 7) referral tracking; 8) performance reporting and improvement; and 9) advanced electronic communication.
The Medical Home model is gaining attention nationally because of its demonstrated ability to lower overall health care expenditures while focusing on prevention and community-based primary care.
|
|
| |
