An Innovative Collaborative Model of Care for Undiagnosed Complex Medical Conditions.

Abstract

* Abbreviations: BCH — : Brenner Children’s Hospital DDCCP — : Declan Donoghue Collaborative Care Program EMR — : electronic medical record PCP — : primary care physician UCMC — : undiagnosed complex medical conditions WFBH — : Wake Forest Baptist Health A recent National Academy of Sciences report titled Improving Diagnosis in Health Care emphasizes the importance of right diagnosis in health care delivery.1 Missed or delayed diagnoses, or incorrect diagnoses, constitute a patient safety problem.2 Diagnostic errors may contribute to ∼10% of patient deaths1 and account for a large portion of malpractice claims.3 One reason for diagnostic errors is the lack of collaboration between clinicians. Collaboration is particularly problematic when clinicians involved in the child’s care practice in different settings.4 The National Academy of Sciences report advocates teamwork in the diagnostic process. Collaborative, interdisciplinary conferences are often used in health care settings to improve patient care. Tumor boards, conferences where clinicians come together to discuss plans of care for their patients with cancer, improve patient outcomes.5 However, collaborative models of care to make diagnoses are not generally available. We describe an innovative model of care for children with undiagnosed complex medical conditions (UCMC) developed in a tertiary care children’s hospital as a result of family partnership with a health care system. Declan was a wonderful baby. He was outgoing, sweet, and talkative. He had a wonderful focus and a beautiful spirit and was always happy and smiling as long as he was playing. Unlike most children, Declan had another list of details that described him. Declan’s medical problem list included fevers, eye scarring, arthritis of the knees, liquid aspiration, … Address correspondence to Savithri Nageswaran, MD, MPH, Department of Pediatrics, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157. E-mail: snageswa{at}wakehealth.edu