On October 17th 2017, Dell Medical School launched its own integrated practice unit centered around complex gynecologic conditions, including chronic pelvic pain, pelvic floor disorders, and vulvar disorders. Centered in a clinical site on Dell Medical School’s health district at The University of Texas at Austin, the IPU serves patients primarily in the Austin-Travis County area.
In addition to being gynecologic problems, chronic pelvic pain, pelvic floor disorders, and vulvar disorders also have a high burden of disease and a lack of effective diagnosis and treatment options. Patients’ medical needs also overlap because the results of each of these conditions can include loss of productivity, decreased quality of life, depression, and decreased sexual functioning. Women who seek treatment are often misdiagnosed and receive improper care.
“I have led large multidisciplinary teams before. This is different. We are committed to measuring the outcomes of what we do and how it impacts patients. We are decreasing barriers to health care access and specialists in a single visit. And the key difference is we do all of this this with a team approach that is centered around our patients and not any one provider.”
The Dell Medical School IPU targets all women in the Austin-Travis County area with pelvic floor disorders, vulvar disorders, or chronic pelvic pain. According to Dell Med leaders, the goal is “to create access to high-quality care for those who have had no access to subspecialty services and for those who have had access but have not received an appropriate diagnosis or treatment.” The IPU exists to fill in a gap for the management of complex gynecologic conditions, as public funding has primarily focused on the development of comprehensive perinatal programs and routine gynecologic services. Through the IPU’s creation, patients have a clear path for the diagnosis and treatment of their conditions, and access to care with positive outcomes.
Given the nature of the complex gynecologic conditions that the IPU addresses, clinicians from multiple fields practice together in one place as a team. Using pathways from which care is personalized for individuals, patients move through the system in predictable ways, allowing the care team to focus on this personalization rather than establishing coordination of the basic pathway for the patient’s complex care. This starts by categorizing patients into care pathways that align with their needs. Patients are asked to complete a specialized questionnaire prior to their first visit with their team that asks about their medical condition and Patient Reported Outcome Measures (PROMs) including symptom severity using validated scales. The questionnaire also asks patients to set their own personalized goals.
Before the patient arrives for her first visit, her case, goals, and PROMs are reviewed and discussed at a team case conference. The team decides how to best customize a team of clinicians around the patient’s individual needs. A medical assistant and nurse practitioner dyad follow patients throughout their pathway and collaborate with other members of the care team to ensure the patient meets her care goals. Depending on the patient’s condition and pathway, other members of her personalized care team may include a surgeon who is trained in female pelvic and reconstructive surgery, a pelvic floor physical therapist, a urogynecologist, a financial counselor, a colorectal surgeon, a sex therapist, and/or a social worker. Thus, rather than having the patient coordinate her care and visit multiple sites for one condition, she can go to one familiar place that coordinates her care for her. The convenience is not only for the patients; all the team members involved in the patient’s care can consult and talk to each other in person, avoiding medical errors and duplications in the care process.
The business model of the IPU facilitates the functioning of the unit. Through Community Care Collaborative, a payer funded by the federal government and health systems in Central Texas, a value-based care bundled payment is given to the IPU for the management of a condition over time. This provides the flexibility needed to allow multiple team members to get involved in a patient’s episode of care. It also enables the customization of a patient’s care, as a team centered around a patient can adapt according to her needs.
In a pilot clinic started prior to the launch of the full-scale IPU, the average wait time for an initial clinic appointment for pelvic floor disorders in the Austin area decreased from 55 to 24 days and wait times for a follow up appointment dropped to only 10 days. While it is too early to have outcomes data from the full scale IPU launched in October 2017, these data indicate the IPU model and care team can efficiently care for women with pelvic floor disorders.
In summary, there are THREE KEY ASPECTS of the IPU care model that make it distinct from a multidisciplinary clinic:
For example, measuring symptom severity and goal tracking before, during, and after pathway graduation
These differences benefit both the clinical care team and the patients they care for. Team members can learn from each other’s expertise and experiences to improve the care they provide. And patients benefit from an ever improving care process that keeps them and the outcomes they care about as its guiding north star.