Thursday, May 2, 2013

Approaches to Coordinated Care

Coordinated care has been touted as a key approach to medicine over the past few years. This approach has been encouraged by rewards and penalties included in the 2010 Affordable Care Act, as well as by private insurers looking to lower costs. Despite this push, the Washington Post reports that communication failures remain disturbingly common due to lack of coordination.

Advocates for hospital patients and their families told the Post that confusion about who is managing a patient’s care contributes to 44,000 to 98,000 deaths from medical errors each year, and a 2010 federal report projected that 10,000 Medicate patients died every month due, at least in part, to hospital error. A 1999 report by the Institute of Medicine cited the fragmented health-care system and patients’ reliance on multiple providers as a leading cause of medical mistakes.

Enter the Hospitalist, doctors that some hospitals have on staff whose duties are to manage a patient’s care, coordinate the various specialists, manage medications, and then oversee the patient transition back home. This position is supposed to take ownership of coordinating care where previously there was a void. The intent is good, but nearly four in ten hospitalists say that they struggle with unsafe workloads at least once per week, according to a survey from Johns Hopkins School of Medicine.

Last summer, the Joint Commission developed a tool for hospitals to help guide communication when a patient is transferred from one hospital setting to another. Some medical centers have taken steps to improve communication, such as assigning color-coded ID tags or scrubs to staff members so patients know who’s a nurse and who’s a doctor, or installing white boards in patient rooms to post information.

This problem speaks to the larger need for a more efficient and reliable way to treat hospital patients. There is a need for identity integrity to ensure that the right procedures, medications, and treatments go to the correct person. It is also needed to ensure that the patient has their full medical history in one place, as opposed to records duplication or mix up. NAHAM is currently working on addressing that need by developing a policy statement on patient identity integrity. 

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