Course 1B: Value-Based Health Care Delivery (Modules 4-5) > 10.Conclusion: Coordinating Care for Patients

10.Conclusion: Coordinating Care for Patients

MODULE 4 | Section 10 of 10

Conclusion: Coordinating Care for Patients

MODULE 4 SUMMARY

Delivering value-based health care means we need to fundamentally refocus care delivery to be designed around the needs of individual patients and their medical conditions. This module explored models for coordinating care for patients, such as patient-centered medical homes (PCMHs) and integrated practice units (IPUs).
The key concepts are to organize care around the needs of patients and to create high-functioning multidisciplinary teams of health professionals who are committed to improving outcomes for individual patients within a defined group (a “panel” or “population”) and who take responsibility for the full cycle of care.

MODULE 4 SECTION SUMMARIES

SECTION 2

Our current health care system can be fraught with frustrating inefficiencies and lack of coordination.

SECTION 3

Care that is not coordinated with the patient contributes to many harms, including: wasted time and missed work, missed or delayed diagnoses, miscommunications, repeat testing, lack of follow-up to test results, and medication errors.

SECTION 4

Fragmented care systems make coordinating care for patients nearly impossible, and tremendously time-consuming and inefficient, for primary care clinicians.

SECTION 5

A highly-effective team working together toward a shared purpose of improved patient outcomes can lead to better care for patients, along with more satisfying and efficient experiences for clinicians.

SECTION 6

Patient-centered medical homes (PCMHs) are quickly spreading across the US as a model for providing first-contact, team-based, coordinated primary care for patients, that ensures enhanced access, proactive chronic disease management, and a systems-based approach to improving quality and safety.

SECTION 7

Integrated Practice Units (IPUs) are multidisciplinary teams of both clinical and nonclinical clinicians organized around a specific patient condition, who treat the conditions over the full cycle of care, and who work together to measure and improve patient outcomes.

SECTION 8

The Dell Medical School women’s health IPU case study describes its systematically designed, team-based approach to solving complex gynecological conditions, with care pathways designed around patients.

SECTION 9

Explore the steps involved in creating an IPU and compare the IPU experience to that of traditional health care.

Learn More

STUDY

Applying the integrated practice unit concept to a modified virtual ward model of care for patients at highest risk of readmission: a randomized controlled trial

This article describes a randomized control trial comparing patients with integrative care post hospital discharge to those with standard care.
Low LL, Tan SY, Ng MJM, Tay WY, Ng LB, et al. PLOS ONE. 2017;12(1): e0168757.

STUDY

A Primary Care Home for Americans: Putting the House in Order

This article outlines the challenges faced by primary care providers and how lack of continuity and coordination affects both patients and providers.

Grumbach K, Bodenheimer T.
JAMA. 2002;288(7):889-893.

STUDY

How primary care practices can improve continuity of care.A Primary Care Home for Americans: Putting the House in Order

A commentary on a study that found evidence that continuity of care lowers hospital utilization.

Gupta R, Bodenheimer T.
JAMA Intern Med. 2013;173(20):1885-1886.

ARTICLE

Will the Patient-Centered Medical Home Transform the Delivery of Health Care?

This policy paper examines the potential of the PCMH and suggests waiting for more evidence of the model’s effectiveness before widespread implementation.

Berenson RA, Devers KJ, Burton RA.
Urban Institute; 2011.

REFERENCES

  1. 1- KXAN. First Look: New UT Health Austin Specialty Clinics Put Focus on Patients. Published October 15, 2017. Accessed December 14, 2017.

Leave a Comment