TEDMED Tuesday: The Great Challenge of Whole-Patient Care

The discussion surrounding the TEDMED Great Challenge – Whole-Patient Care is currently underway. Whole-Patient care is a wonderful concept, yet a false reality for many of those who seek treatment from multiple doctors. The idea of whole-patient care is a team approach to treatment. It often happens in a rehabilitation hospital setting or a critical care unit where a team of specialists are needed to ensure a patient will thrive.

But what happens to a patient once they have healed beyond the point of in-patient care? How does a patient receive treatment for the various conditions or diseases which may require visits to a variety of specialists? And what about the patient who has never needed in-patient care, but needs the help of many physicians to treat their specific condition? Who is looking out for the patient’s best interests? Who is communicating between all of the physicians? Treating for a patient’s care needs as a whole, instead of looking at each medical issue individually, is critical, and that is why this discussion is so important.

Who oversees all of the overlapping issues or interrelated opportunities for a patient’s care? In the last few decades, patients or loved ones have had to become their own advocates, as the number of medical specialists (and specialties) continues to grow while the number of primary care physicians continues to shrink. However, being an advocate of care isn’t easy, and navigating the best care options can be missed if advocates are ill, overloaded, or not schooled in the medical field. But being an advocate of care isn’t the only concern of this Great Challenge.

As whole-patient care is examined, acknowledging that care extends beyond treating a patient’s disease or medical condition to include a holistic approach to wellbeing is also crucial. Addressing a patient’s social support system, economic situation, spiritual beliefs, cultural background, and values are also critical to providing whole-patient care. An organization which is working to support patient-centered care is the Patient Centered Care Collaborative.

One model that has been working for supporting patient-centered care is a team-based approach using a family-centered medical home. A family-centered medical home is not a building, house, hospital, or home healthcare service, but rather an approach to providing comprehensive primary care through a patient-driven, team-based approach that delivers efficient, comprehensive and continuous care through active communication and coordination of healthcare services.

Our nation’s largest healthcare provider, the U.S. Veterans Health Administration (VA), has implemented this model and is finding great success. In 2010 the VA embarked on a three-year plan to build patient-centered medical homes in more than 900 primary care clinics across the nation. The model is organized around an interdisciplinary approach and clinical effectiveness, and included an investment of $227 million to hire additional staff and provide training. Within one clinic alone the VA saw the following results:

  • shortened the waiting time for appointments from as long as 90 days to same-day access
  • reduced the percentage of inappropriate emergency department visits from 52 percent to 12 percent
  • and in just three months reduced hemoglobin A1c scores by at least one point in 33 percent of patients with poorly controlled diabetes.

Beyond that, the VA created Patient Aligned Care Teams (PACT), which are teams in which each Veteran works together with healthcare professionals to plan for whole-person care and lifelong health and wellness. A prime example of how PACT has been implemented comes from a story about the New Mexico VA healthcare system which discusses how it is going about the culture change and embracing PACT. Revisions to the system include all primary care and community based outpatient clinics, in order to improve primary care delivery by increasing access, coordination of care, continuity of care and improving communication.

To learn more about the movement in pediatric care for the family-centered medical home, visit the National Center for Home Implementation. It’s wonderful to know that strong models and positive data for whole-patient care already exist and can be utilized. It would be great to see this approach and these insights applied to the general healthcare consumer or at least provided as an option.

In the next week, Steelcase Health will take a closer look at the VA and wellness. Through our experience with the VA, we have learned firsthand the significant positive impact and advancements the VA has had on the way medicine is practiced. So be sure to read our upcoming blogs, and provide us with your feedback.

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