Interdisciplinary Care Model Research Articles

Measuring the extent and drivers of integration within primary care teams

Introduction: Given its core attributes as the gateway to the health system, the primary care sector is increasingly emphasized as a key player in the integration of care across providers and settings. Ontario’s primary care sector has evolved considerably with the introduction of new inter-disciplinary models of primary care, including Family Health Teams FHTs and Community Health Centres CHC. However, our understanding of the specific features that enable integration within primary care teams is limited. This study sought to examine the extent and drivers of intra-organizational integration collaboration within team-based primary care models in Ontario specifically FHTs and CHCs. Methods: Organizational features i.e., information technology [IT] capacities, information exchange, and rurality etc. and team characteristics size and provider attributes were assessed via the Organizational Profile Questionnaire, which was completed by the Executive Director for each CHC/FHT. Intra-organizational integration was measured using the Collaborative Practice Assessment Tool CPAT - a validated survey instrument, designed to measure collaboration within healthcare teams. All providers involved in care delivery were invited to complete the CPAT. A multi-variate linear regression analysis was conducted to explore the drivers of CPAT scores. Results: A total of 44/73 CHCs 60% participation rate participated in this study, and 738 providers from a broad range of disciplines completed the CPAT. The response rate across CHCs was 45%, and 10% of respondents were male. Average age and length of employment were 43 years and 7 years respectively, and roster/panel size was approximately 4600 patients. The average CPAT score for CHCs was 47.21 SD = 1.97, Median: 47.25, Min: 43.74 and Max: 52.01. Regression analyses revealed that rurality, number of years in operation, roster/panel size, number of practice locations, IT capacity and information exchange were statistically significant predictors of CPAT scores. Data collection in FHTs is underway. Discussion: The negative association between roster/panel size and CPAT score reflects qualitative insights around time constraints faced by providers in their effort to collaborate effectively within teams. Increasing the number of practice locations was associated with a lower CPAT score indicating challenges associated with dispersion, whereas rurality was associated with a higher CPAT score. A high level of IT capacity was associated with a higher CPAT score - illustrating the role of technology in promoting integration efforts. In contrast, high levels of information exchange were associated with a lower CPAT score. Conclusions: A narrow distribution of CPAT scores was observed for CHCs. Organizational features, specifically IT capacity, rurality and years in operation are important enablers of integration within CHCs. Lessons learned: Team characteristics including size and provider attributes were not associated with CPAT scores. The inverse relationship between information exchange and CPAT score indicates possible gaps in perceptions of information exchange between executive leadership and individual providers. Limitations: Since participation was optional there is potential for selection bias. Given the cross-sectional study design, changes in intra-organizational integration over time cannot be ascertained. Suggestions for future research: Examining the association between integration within primary care teams and key system and patient-level outcomes are important next steps.

SUDEP and Grief: Overview and Current Issues.

The medical community and the general public are aware of sudden deaths in apparently healthy infants (SIDS) and in cases of cardiac arrest (SCD). However, there is a third, less-well known, form of sudden death that occurs in persons with epilepsy (SUDEP). This paper provides a detailed overview what is known about SUDEP, including the current important, unresolved issues being considered in the field (research, education, informed consent). This paper also includes an overview of the grieving process common to all three conditions. Again, the current issues being considered in the field of grieving are presented (major depression, posttraumatic stress disorder). It is written for physicians, including psychiatrists, and for the health community beyond neurologists and serves as a provider resource for persons with epilepsy, their families, and for the general public. This information about SUDEP and grief becomes also additionally important as national health care moves toward an interdisciplinary primary care model of service delivery.

PICU Provider Supply and Demand: A National Survey.

To describe physicians' and nurse practitioners' perceptions of the national and local PICU physician and other provider supply in institutions that employ PICU nurse practitioners, assess for differences in perceptions of supply, and evaluate the intent of institutions to hire additional nurse practitioners to work in PICUs. National, quantitative, cross-sectional descriptive study via a postal mail survey from October 2016 to January 2017. Institutions (n = 140) identified in the 2015 American Hospital Association Annual Survey with a PICU who employ PICU nurse practitioners. PICU physician medical directors and nurse practitioners. None. There were 119 respondents, representing 93 institutions. Responses were received from 60 PICU medical directors (43%) and 59 lead nurse practitioners (42%). More than half (58%) of all respondents reported the national supply of PICU physicians is less than demand and 61% reported the local supply of PICU providers (physicians in all stages of training, nurse practitioners, and physician assistants) is less than demand. Of the respondents from institutions that self-reported a local provider shortage (n = 54), three fourths (78%) reported plans to increase the number of PICU nurse practitioners in the next 3 years and 40% were likely to expand the nurse practitioner's role in patient care. Most PICU medical directors and lead nurse practitioners in institutions that employ PICU nurse practitioners perceived that national and local supply of providers to be less than the demand. Nurse practitioners are employed in PICUs as part of interdisciplinary models of care being used to address provider demand. The demand for more PICU nurse practitioners with expanded roles in care delivery was reported. Further evaluation of models of care and provider roles in care delivery can contribute to aligning provider supply with demand for care delivery.

Interdisciplinary aerodigestive care model improves risk, cost, and efficiency

ObjectiveThis study sought to evaluate the impact of an interdisciplinary care model for pediatric aerodigestive patients in terms of efficiency, risk exposure, and cost. MethodsPatients meeting a standard clinical inclusion definition were studied before and after implementation of the aerodigestive program. ResultsAerodigestive patients seen in the interdisciplinary clinic structure achieved a reduction in time to diagnosis (6 vs 150 days) with fewer required specialist consultations (5 vs 11) as compared to those seen in the same institution prior. Post-implementation patients also experienced a significant reduction in risk, with fewer radiation exposures (2 vs 4) and fewer anesthetic episodes (1 vs 2). Total cost associated with the diagnostic evaluation was significantly reduced from a median of $10,374 to $6055. ConclusionThis is the first study to utilize a pre-post cohort to evaluate the reduction in diagnostic time, risk exposure, and cost attributable to the reorganization of existing resources into an interdisciplinary care model. This suggests that such a model yields improvements in care quality and value for aerodigestive patients, and likely for other pediatric patients with chronic complex conditions.

Expanding the role of clinical pharmacists on interdisciplinary primary care teams for chronic pain and opioid management

BackgroundFacilitating appropriate and safe prescribing of opioid medications for chronic pain management in primary care is a pressing public health concern. Interdisciplinary team-based models of primary care are exploring the expansion of clinical pharmacist roles to support disease management for chronic conditions, e.g. pain. Our study aims to 1) identify roles clinical pharmacists can assume in primary care team based chronic pain care processes and 2) understand the barriers to assuming these expanded roles.MethodsSetting: Veterans Health Administration (VA) has implemented an interdisciplinary team-based model for primary care which includes clinical pharmacists. Design: We employed an inductive two part qualitative approach including focus groups and semi-structured interviews with key informants. Participants: 60 members of VA primary care teams in two states participated in nine preliminary interdisciplinary focus groups where a semi-structured interview guide elucidated provider experiences with screening for and managing chronic pain. To follow up on emergent themes relating to clinical pharmacist roles, an additional 14 primary care providers and clinical pharmacists were interviewed individually. We evaluated focus group and interview transcripts using the method of constant comparison and produced mutually agreed upon themes.ResultsClinical pharmacists were identified by primary care providers as playing a central role with the ongoing management of opioid therapy including review of the state prescription drug monitoring program, managing laboratory screening, providing medication education, promoting naloxone use, and opioid tapering. Specific barriers to clinical pharmacists role expansion around pain care include: limitations of scopes of practice, insufficient institutional support (low staffing, dedicated time, insufficient training, lack of interdisciplinary leadership support), and challenges and opportunities for disseminating clinical pharmacists’ expanded roles.ConclusionsExpanding the role of the clinical pharmacist to collaborate with providers around primary care based chronic pain management is a promising strategy for improving pain management on an interdisciplinary primary care team. However, expanded roles have to be balanced with competing responsibilities relating to other conditions. Interdisciplinary leadership is needed to facilitate training, resources, adequate staffing, as well as to prepare both clinical pharmacists and the providers they support, about expanded clinical pharmacists’ scopes of practice and capabilities.

Implementation issues relevant to outpatient neurology palliative care

There is growing interest in the application of palliative care principles to improve care for patients and families affected by neurologic diseases. We developed an interdisciplinary outpatient clinic for patients and families affected by neurologic disorders to better address the problems faced by our highest need patients. We have developed and improved this program over the past three years and share several of our most important lessons as well as ongoing challenges and areas where we see our clinic evolving in the future. We provide a description of our clinic logistics, including key steps in the initiation of the clinic, and provide descriptions from similar clinics at other institutions to demonstrate some of the variability in this growing field. We also provide results from a formal one-year quality improvement project and a one-year retrospective study of patients attending this clinic. Our clinic has grown steadily since its inception and maintains high satisfaction ratings from patients, caregivers, and referring providers. To maintain standardized and efficient care we have developed materials for patients and referring physicians as well as checklists and other processes used by our interdisciplinary team. Feedback from our quality improvement project helped define optimal visit duration and refine communication among team members and with patients and families. Results from our chart review suggest our clinic influences advance care planning and place of death. Common referral reasons include psychosocial support, complex symptom management, and advance care planning. Current challenges for our clinic include developing a strategy for continued growth, creating a sustainable financial model for interdisciplinary care, integrating our services with disease-specific sections, improving primary palliative care knowledge and skills within our referral base, and building effective alliances with community neurologists, geriatrics, primary care, nursing homes, and hospices. Specialized outpatient palliative care for neurologic disorders fills several important gaps in care for this patient population, provides important educational opportunities for trainees, and creates opportunities for patient and caregiver-centered research. Educational initiatives are needed to train general neurologists in primary palliative care, to train neurologists in specialist palliative care, and to train palliative medicine specialists in neurology. Research is needed to build an evidence base to identify patient and caregiver needs, support specific interventions, and to build more efficient models of care in both academic and community settings.

CARING FOR THE CAREGIVER: EXPLORING THE EXPERIENCE OF CAREGIVING FOR A CHID WITH MEDICAL COMPLEXITY

Abstract BACKGROUND Children with medical complexity (CMC) represent a growing population in the paediatric healthcare system. CMCs’ multiple health needs, illness severity, and fragility lead to a high degree of caregiver burnout, parental employment loss, and other social and financial consequences. Healthcare providers must consider a holistic view of the family, including consideration of social determinants of health [SDOH]: socio-economic status, employment, quality of housing, availability of social support, and access to healthcare services. This study addresses a gap in current research by exploring how caring for a CMC exacerbates social inequalities, and how these challenges may be mitigated. OBJECTIVES 1. What are the SDOH impacting CMC and their families? 2. How do families report the impact of their child’s medical complexity on their social circumstances? DESIGN/METHODS A qualitative description approach was used to enable rich data collection through semi-structured interviews until thematic saturation was reached. Nine interviews were conducted with CMC caregivers who were chosen by purposeful sampling. The interview guide was developed by expert consultation and iteratively refined. Ethics approval and written consent were obtained. Interviews were recorded and transcribed verbatim. Three team members independently coded the interviews for recurrent themes to inform qualitative content analysis. RESULTS Caregiving for a CMC is all-consuming, requiring parents to take on roles including planner, medical professional, medical educator, and advocate. Parents of CMC report three major areas negatively impacted by caregiving: 1) physical and mental health; 2) personal relationships; and 3) finances. Additionally, three themes emerged describing enablers for resiliency: 1) the CMC’s health status when well or stable in hospital; 2) acceptance of one’s limitations as a caregiver and of the family’s ‘new normal’; and 3) broad supports including medical, personal, financial, and educational. CONCLUSION The wellbeing of CMC families is impacted by medical and social factors. An interdisciplinary model of care may offset some of the caregiver’s advocacy and medical educator responsibilities. Paediatricians can support families of CMC by providing comprehensive care for all components of the child’s health status, and by including routine assessment of the family’s SDOH. Finally, explicit discussion about parental expectations and caregiver burnout helps foster a positive therapeutic relationship with the family.

Interdisciplinary Home Visits for Individuals with Advanced Parkinson's Disease and Related Disorders

Parkinson's disease (PD) is a complex, multisymptom, neurodegenerative disease affecting primarily older adults. With progression, many individuals become homebound and removed from coordinated, expert care, resulting in excess morbidity, mortality, and healthcare expenditures in acute care settings and institutions. Home visit care models have achieved the triple aim of improving individual and population health while reducing costs in many frail, community-dwelling geriatric cohorts. This study details a novel, interdisciplinary home visit program specifically designed for individuals with PD and related disorders and their family caregivers built upon best practice principles in the care of multimorbid older adults. At each quarterly home visit, a movement disorders-trained neurologist, social worker, and nurse work in parallel with the individual and caregiver to complete a history, physical, detailed medication reconciliation, psychosocial needs assessment, and home safety assessment. A comprehensive, person-centered plan is agreed upon, referrals to community resources are made, standardized documentation is shared, and follow-up communication is instituted. In the first 2 years, 272 visits were conducted with 85 individuals who represent one of the oldest, most disabled PD populations reported. Satisfaction with and retention in the program were high. This study represents the first translation of the success of interdisciplinary and home-based geriatric care models to a population with a specific neurological disease. Preliminary evidence supports the need for such programs in vulnerable populations. Future studies will prospectively assess person-centered outcomes, the effect of using telemedicine on sustainability, and cost effectiveness.

Revisiting the Viability of the Developmental-Behavioral Health Care Workforce.

* Abbreviations: ABP — : American Board of Pediatrics ABPN — : American Board of Psychiatry and Neurology DB — : developmental-behavioral DBP — : developmental-behavioral pediatrics NDD — : neurodevelopmental disabilities In their article entitled “2015 Developmental Behavioral Pediatrics Workforce Survey,” Bridgemohan et al1 argue that the current system for managing US children with complex developmental-behavioral (DB) conditions is not viable. Despite high demand for services as measured by the increasing prevalence and complexity of childhood DB conditions, the provider supply remains limited. Results from their survey with general and subspecialty physicians and nurse practitioners, who self-identified as assessing and treating children with DB needs, suggest inadequate overall numbers of providers and overworked physicians; in addition, one-third of physician respondents reported planned retirement in 3 to 5 years.1 Two critical questions arise: (1) given a 48% response rate across a convenience sample from 3 membership organizations, are the results generalizable to the larger DB workforce, and (2) if yes, what are the implications for the health care workforce caring for children with DB conditions? Although it is difficult to determine the study’s generalizability by using publicly available information, additional data shed light on supply constraints. Certification data suggest the survey captured 261 of 775 (33.7%) of … Address correspondence to Laurel K. Leslie, MD, MPH, American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514. E-mail: lleslie{at}abpeds.org

Interdisciplinary Care Model Independently Decreases Use of Critical Care Services After Corrective Surgery for Adult Degenerative Scoliosis

Interdisciplinary management of elderly patients requiring spine surgery has been shown to improve short- and long-term outcomes. The aim of this study was to determine whether an interdisciplinary team approach mitigates use of intensive care unit (ICU) resources. A unique comanagement model for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Peri-operative Optimization of Senior Health Program (POSH) was launched with the aim of improving outcomes in elderly patients (>65 years old) undergoing complex lumbar spine surgery. In this model, a geriatrician evaluates elderly patients preoperatively, comanages daily throughout hospital course, and coordinates multidisciplinary rehabilitation, along with the neurosurgical team. We retrospectively reviewed the first 100 cases after the initiation of the POSH protocol and compared them with the immediately preceding 25 cases to assess the rates of ICU transfer and independent predictors of ICU admission. A total of 125 patients undergoing lumbar decompression and fusion surgery were enrolled in this pilot program. Baseline characteristics and intraoperative variables, as well as number of fusion levels and duration of surgery, were similar between both cohorts. There was a significant difference in the use of ICU services (ICU admission rates) between both cohorts, with the non-POSH cohort having a 3-fold increase compared with the POSH cohort (P < 0.0001). In a multivariate analysis, lack of an interdisciplinary comanagement team approach was an independent predictor for ICU transfers in elderly patients undergoing corrective surgery (odds ratio 8.51, 95% confidence interval 2.972-24.37, P < 0.0001). Our study suggests that an interdisciplinary comanagement model between geriatrics and neurosurgery is independently associated with reduced use of critical care services.

Chapter 2 - Sports neurology as a multidisciplinary field

A multidisciplinary approach within sports neurology fills a critical role in the management of athletes with neurologic injury. This model promotes streamlined access to sports medicine providers who can offer high-quality multispecialty care in a collaborative manner, to provide optimal outcomes for athletes. This chapter highlights the rise of the multidisciplinary care approach in nonathletic healthcare settings and introduces the concept of the interdisciplinary sports medicine care model. Next, we review the roles of medical providers who are integral in effective management of sport-related concussion, followed by a discussion of the athletic healthcare teams that treat other sport-related neurologic injuries and athletes with pre-existing neurologic conditions. Finally, we note important educational, legal, and independent medical care issues in athletic healthcare settings, and summarize the applicability of multidisciplinary and interdisciplinary care models to the subspecialty of sports neurology.

Examining the artist–patient relationship in palliative care. A thematic analysis of artist reflections on encounters with palliative patients

Background: Although therapeutic arts are used in the palliative care setting, little has been described about what happens during the artist–patient encounter and how these interactions can complement and integrate into the interdisciplinary model of palliative care. The objective of this study is to describe the artist–patient encounter and how artists can function in the palliative interdisciplinary model of care. Methods: Authors reviewed 229 reports written by artists about encounters with palliative patients, and performed thematic analysis on 95. Results: Artists describe physical, emotional and spiritual responses by patients including relaxation, invigoration and accessing spirituality, some of which were unique to the artist–patient interaction. Artists also described personal reactions including themes of professional fulfillment, kinship and empathy with patient suffering. Themes surrounding the artist–patient bond and trust also emerged. Conclusions: The artist–patient encounter has an effect on both patients and artists, and can create a therapeutic relationship between them. Artists provide unique perspectives and contribute to care paradigms when integrated with the palliative team.

Nurse practitioners: Developing the next generation of health care leaders through an internship program

The current health care environment demands competent providers who possess advanced knowledge and skills necessary to care for an increasingly acute patient population. Nurse Practitioners (NPs) are uniquely positioned to meet the challenges of today’s health care climate because they blend their ability to treat illness with a strong emphasis on patient safety and outcomes while providing patient- and family-centered care. The role of the NP requires sophisticated clinical and critical thinking skills that foster the ability to synthesize theoretical, scientific, and contemporary clinical knowledge for the assessment and management of both healthy and illness states. It is crucial that NPs possess advanced skills to provide safe and effective patient care outcomes. The literature suggests that there is a transition period after graduation for novice NPs. Developing additional focused educational opportunities to supplement the training phase of their graduate education can better prepare student NPs and consequently enhance this transition phase. As a result, newly licensed NPs can deliver high-quality, safe patient care sooner after obtaining their advanced practice license. At a time when health care reform is rapidly evolving, it is critical that NPs are reliable, competent professionals. Houston Methodist Hospital created an employment-based educational opportunity for elite graduate NP students: Leading Education and Advancing Professionals (LEAP). This 12-month program is a structured evidence-based internship program that incorporates didactic training, clinical rotations, and simulation. Students are provided hands-on training that features interdisciplinary and collaborative care model components from experienced Houston Methodist NPs. The goal is to help develop the next generation of health care providers in which the expectation is to lead and not follow in meeting today’s health care challenges. The aim of this article is to present an overview of the LEAP program.

30.1 Pediatric Medicine Updates for the Child Psychiatrist: Caring for Transgender and Gender-Nonconforming Youth

According to recent population-based studies, approximately 0.3 to one percent of the population in the United States identifies as transgender or gender nonconforming. Transgender is an umbrella term that refers to individuals whose gender identity and expression may differ from their sex assigned at birth. Transgender adolescents are at high risk for poor physical and mental health outcomes, including high rates of human immunodeficiency virus infection, depression, anxiety, and suicide attempts. These health risks are attributed to the discrimination and isolation frequently reported by transgender individuals. Recently, interdisciplinary models of care have been developed to provide medical and psychosocial support for gender-nonconforming youth. This presentation will review key concepts, including distinguishing between gender identity and sexuality, diagnosis of gender dysphoria, and medical options for treatment, including puberty blockers and cross-gender hormones, as well as gender-affirming surgical procedures.

Healthcare professionals' perceptions of neglect of older people in Mexico: A qualitative secondary analysis.

To describe healthcare professionals' perceptionsof neglect of older people in Mexico. Mistreatment of older people, particularly neglect, has emerged as a significant public health concern worldwide. However, few studies have been conducted to examine neglect of older people in low- and middle-income countries. Most research has focused on estimating the prevalence of neglect in older populations with little emphasis on the perceptions of healthcare professionals and their role in addressing neglect of older people. Qualitative secondary analysis. The parent study consisted of nine focus groups conducted with healthcare professionals at five public hospitals in Mexico. The purpose of the parent study was to perform a needs assessment to determine the feasibility of adapting the Nurses Improving Care for Healthsystem Elders programme to Mexico. A qualitative secondary analysis with directed content analysis approach was used to extract data related to neglect of older people. A total of 89 participants representing healthcare professionals from several disciplines were interviewed. Three themes emerged: (i) The main point is not here; (ii) We feel hopeless; and (iii) We need preparation. Participants reported distress and hopelessness related to neglect of older people. Lack of community-based resources was noted as contributing to neglect. Increased education regarding care of older people for both caregivers and healthcare professionals and greater interdisciplinary collaboration were identified as potential solutions to combat neglect. Community-based services and resource allocation need to be re-evaluated to improve the care of older Mexicans. Interdisciplinary models of care should be developed to address concerns related to neglect of older people. Neglect negatively impacts healthcare professionals' ability to adequately care for older patients. There is a need to invest in community-based services and models of care to address these concerns.

Recommendations for the Establishment of Disorders/Differences of Sex Development Interdisciplinary Care Clinics for Youth

PurposeProvide recommendations for the development of an interdisciplinary care (IDC) clinic for the treatment of youth with disorders/differences of sex development (DSD). DSD consist of a group of complex congenital medical disorders in which the development of chromosomal, gonadal, or anatomical sex is atypical. Youth with DSD require care from multiple specialized healthcare disciplines, including several medical specialties, surgery, nursing, and mental health. MethodRecommendations are based on an interdisciplinary care clinic model that allows for a team of relevant professionals who share knowledge, ideas, and responsibility of care. The framework established in this article is based largely on experiences at an established DSD clinic, as well as observations of multiple clinics across the United States. ResultsPreliminary outcome data on clinic adherence to treatment protocol under an IDC model are provided. ConclusionsTo meet the diverse healthcare needs of youth with DSD, comprehensive care clinics are recommended; however, few such clinics exist in the United States. Establishing new comprehensive DSD clinics can be challenging due to the highly unique treatment of DSD, but the current paper expands the literature available to guide clinic development in the United States.

Interdisciplinary model of care (RADICALS) for early detection and management of chronic obstructive pulmonary disease (COPD) in Australian primary care: study protocol for a cluster randomised controlled trial

IntroductionUp to half of all smokers develop clinically significant chronic obstructive pulmonary disease (COPD). Gaps exist in the implementation and uptake of evidence-based guidelines for managing COPD in primary care....

Interdisciplinary Care Team with Pharmacist in a Community-based HIV Clinic

BackgroundHuman immunodeficiency virus (HIV) infection presents a significant burden, especially in the Washington, DC area. Literature is limited in describing the role of pharmacists in the outpatient clinic setting to provide patient-centered pharmaceutical care for patients with HIV. ObjectiveOur study aims to describe an interdisciplinary HIV care model including a clinical pharmacist at a community-based transcultural clinic in the Washington, DC area, and to describe the role of the pharmacist as indicated by an association between non-adherence to antiretroviral therapy (ART) and an ART regimen change. MethodsUsing the electronic health record at the clinic from May 2011 through July 2013, 53 patients were identified who were referred to the clinical pharmacist. ResultsThe average age of the patients with HIV was 46.57 years in the clinic. About 28% of patients had documented non-adherence to ART and 30% of patients had one or more ART regimen changes during the study period. Medication non-adherence was a significant predictor of ART regimen change (ORadj 8.44; 95% CI 1.91–37.29). Substance use was a strong predictor of ART regimen change (ORunadj 3.47; 95% CI 1.02–11.81), but the relationship disappeared in the multivariate analysis. ConclusionsA strong association between pharmacist's evaluation of non-adherence to ART and a regimen change was demonstrated and the role of the pharmacist as the interdisciplinary team member was described. A follow-up study should be made to assess the services provided by the pharmacist on clinical, economic, and humanistic outcomes in the community-based clinical setting.

Anesthesiology Residency Curriculum and Implementation of a Perioperative Surgical Home Curriculum: A Survey Study

The perioperative surgical home (PSH) is a physician-led, interdisciplinary, and patient-centered model of perioperative care that focuses on patient outcomes and comprehensive care management. Many studies to date have looked at the clinical implementation of varied PSH models with promising results discussed. There are no studies directly examining concrete plans for the various Accreditation Council for Graduate Medical Education (ACGME) anesthesiology residency programs to implement augmented PSH training into curricula. The aim of this survey study was to better assess current residency training in PSH. An 18-question survey developed by a team of research personnel familiar with the PSH was sent to all ACGME accredited anesthesiology training programs in the United States. Responses were quantified, and construct and external validity of the survey tool examined. 41% of the programs responded. 89% (95% CI 78-96%) of programs reported moderate or better understanding of the PSH. 34% (21-47%) had incorporated additional PSH training in the previous three years, and 32% (with no significant correlation to the previous group) had plans to integrate more training in the next 3 years. Overall, the surveyed program directors voiced understanding of the value of the PSH model in patient care but remained hesitant to incorporate training specific to PSH into the anesthesiology residency curricula.

Promoting Socially Just Healthcare Systems: Social Work’s Contribution to Patient Navigation

Patient navigation is an emerging area of healthcare practice that uses an interdisciplinary and integrated care model designed to reduce health disparities and improve health outcomes. The authors define patient navigation, delineate the alignment of social work competencies with patient navigator requirements, and argue for a clear social work role and presence as patient navigators in interdisciplinary healthcare delivery. Social workers are well-equipped to carry out a variety of patient navigator responsibilities due to their unique skill of social justice advocacy as a macro-level intervention. Through involvement in patient navigation, social work leaders can promote the development of socially just healthcare systems that respect the dignity and worth of all patients.