Collaborative Patient Care: Setting a Path to Success

Introduction to Collaboration

Patient care has become increasingly complex because of increased diagnostic, medical, and treatment options. Start with the fact the US population, as well as other developed countries, is aging. Once 1 in 10 persons in the 1980s, those 65 and older are projected to be 1 in 5 in 2040.

The proportion is a result of the increase in longevity and stagnating fertility rates. Compounding this is that more than half of these adults report taking at least four prescription drugs for chronic diseases. As a result, a patient with chronic diseases is at risk of needing hospitalization for complications.

In the past, it was common for a primary care doctor (PCP) to manage someone’s health in both the clinic and hospital settings.  In the late 1990s, this paradigm changed when hospitalists, physicians skilled at managing hospitalized patients, became an increasingly accepted discipline. The general practitioner’s scope was relegated to the outpatient setting. Some studies of patient care by hospitalists compared to PCP’s showed improved patient outcomes with hospitalists (though a recent study found a value in the care delivered by the patient’s provider).

Whether inpatient or outpatient, care requires a collaborative front. This article will outline the importance of collaboration in medical care.

The Importance of a Collaborative Practice

The World Health Organization defines the collaborative practice as “multiple health workers from different professional backgrounds working together with patients, families, caregivers, and communities to deliver the highest quality of care.”

If you were ever hospitalized, you might recall the many doctors, nurses, and therapists that assisted in your care during your stay. You may wonder how care delivery can be optimized when so many people are involved in your care. With so many moving targets, like studies, procedures, and medications, how can errors be prevented?

There is a lot of discontinuity in today’s management of the hospitalized. As a result, there are risks of medical errors from hand-offs from the admitting physician to the covering physician or nocturnist.  Some estimates claim that nearly one in ten patients (9.2%) are harmed; a significant proportion is considered preventable. The most common errors were surgical and medication-related. One of the greatest reasons for errors is a communication breakdown.

Managing patients in the hospital is a lot like being on a team. Important characteristics of collaborative care include communication, leadership, care coordination, and discharge planning. Frequent, regular contact allows the team to develop trust and focus on a unified plan, drawing from the expertise of each member.

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Outcomes of a Collaborative Care Model

Hospital managers can develop programs that improve collaborative care. One hospital system, ThedaCare, has made large strides in improving quality measures for conditions such as pneumonia and heart failure, patient and employee satisfaction, length of stay, and costs. One characteristic of such a system is bedside multi-disciplinary rounds with the physician, pharmacist, nurse, and discharge planner. Another characteristic is ongoing planning and frequent huddles. All team members are considered equally valued, and a partner is centered on providing a personalized care approach.

Similar models have been developed in the outpatient setting. Clinics are increasingly incorporating care from multiple providers, including case managers, psychologists, pharmacists, and other therapists. These types of models are gaining momentum in outpatient mental health care as well. Like in hospitals, a team model with greater cohesiveness is also associated with improved clinical outcomes and patient satisfaction in the outpatient setting.

Collaboration: My Take

In this age of electronic health records and other technologies, the strong relationship forged by physicians and patients in primary care once common is becoming harder to develop.  This is unfortunate because patient-provider communication is critical in healthcare.

To improve patient satisfaction, diagnostic capability, error risk, readmission rate, and even provider satisfaction and lower medical-legal risk, providers need only nurture the doctor-patient relationship and maintain excellent communication. Communication can also improve the likelihood for a physician to make a diagnosis, even with a diagnostic challenge.

Patient satisfaction can even be a surrogate marker for the quality of communication and the strength of the doctor-patient relationship. For example, one study showed high patient satisfaction scores correlated with patients that were 39% less likely to be readmitted. Thus, optimal communication seems to be a bridge that improves diagnosis, care, and treatment.

William Fortunato at Pexels

Summary

Collaboration in healthcare promotes the shared pursuit of providing excellent patient care. Every physician, nurse, or therapist involved in the care applies their unique knowledge- and experience-base to ensure that a patient has a prompt and thorough evaluation and treatment plan. Thus, collaboration is important on all levels of patient care and leads to improved satisfaction of both patient and provider and outcomes.