Abstract
BackgroundThe demand for endocrinology services is growing worldwide, particularly among minority and underserved populations, mainly due to the rapid global increase of diabetes. The medical education of endocrinologists is a resource consuming process and is mainly hospital-based. Yet, given the chronic nature of endocrine morbidity, the greatest demand for endocrinology services is in the community. However, an isolated endocrinologist cannot cope with the rapid changes in the field. Limited funding of hospital facilities does not allow for the establishment of a freestanding endocrine-center; thus, the Community- Hospital Integrative Model of Healthcare (Co-HIMH) was developed and implemented in an Israeli government hospital and is presented as an approach for achieving excellence in endocrinology care.AimTo describe the design, function and challenges of the Co-HIMH.Model descriptionOriginally, three pillars: 1) the hospital unit as a regional expertise resource, 2) Co-HIMH endocrine providers participating in both community and hospital services, and 3) integrated information flow between health-care providers, supported the integration between hospital and community networks.ResultsThe community and hospital endocrine human resources were increased to create attainable and accessible endocrine services in the community and hospital. Collaborative interaction between healthcare providers increased both continuity of care and efficient patient navigation. Endocrine hospital referrals for specialized procedures have grown. Within this area of low socioeconomic status, continued medical endocrine education was conducted introducing state-of-the-art treatments. The essence of these achievements was maintained by continuous training of fellows. During the years that the Co-HIMH operated, it certified 14 % of all endocrinology fellows in Israel. Unresolved issues regarding employee rights and formalization of the Co-HIMH status are significant challenges.ConclusionsIn the era of limited resources and increased healthcare demand, creative infrastructures are required. This article provides a successful example of a preliminary model and proposes future needed modifications.
Highlights
The demand for endocrinology services is growing worldwide, among minority and underserved populations, mainly due to the rapid global increase of diabetes
During the years that the Community- Hospital Integrative Model of Healthcare (Co-HIMH) operated, it certified 14 % of all endocrinology fellows in Israel
The greatest demand for endocrinology services is in the community, endocrinology fellowships, continuing medical endocrine education (CME) and research, collaborative consults, exposures to rare endocrine diseases, and access to acute care patient services, are almost always hospital-based
Summary
The demand for endocrinology services is growing worldwide, among minority and underserved populations, mainly due to the rapid global increase of diabetes. With the rapid change in the perception of current endocrinology towards patient-centered individualized treatment plans, including thyroid and neuro-endocrine oncology, the scene of a single physician managing the patient’s ‘case’ in an isolated clinic is becoming rapidly obsolete. Against this background, the paucity of hospital based endocrine procedures coupled with system resource shortages led healthcare policy makers to question the need for hospital-based endocrinology. Policy makers are often not aware of, or perhaps do not take into account, the fundamental role of intra-hospital collaboration and hospital-based CME and research designed to ensure treatment expertise and to save lives and potentially reduce future costs
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