Models for Managing Complex Cases in Both Inpatient and Outpatient Settings

Abstract

Models of integrated, multispecialty treatment for complex clinical cases have evolved as the awareness of the ubiquity of such cases and their cost to the medical system has grown. Traditionally, primary care physicians focused mainly on treating systemic medical illness. Generally, these treatments had a dyadic (patient-primary care physician) or triadic (patient-primary care physician-specialist physician) structure. The patient’s overall care was “owned” by the primary care physician, and the physician-patient relationship was the basis of the clinical interaction. Allied health personnel such as physician assistants or nurses were regularly involved in patient care, but the physician remained central to the treatment relationship. Newer treatment models appropriate for treating complex cases tend to be comprehensive, emphasizing coordination of medical services through multidisciplinary patient care teams. With “integrated care,” the targeted pathology is generally comorbid illness, frequently consisting of combined systemic medical-psychiatric illness, but also nonmedical conditions with a psychological and social basis. Both new and older models for care for complex cases are represented in this chapter.