Collaborative Care: A Health Central Explainer
"Any experiment in which we try to integrate care is better than what we've got now," said Dr. Douglas Hough, an expert in behavioral economics in health care and health care economics and associate professor at the Johns Hopkins Carey Business School. He continued, "Care is just so fragmented today."
A recent study found that "collaborative care facilities" produced better health outcomes for patients with knee osteoarthritis than standard delivery of care. Collaborative care facilities – also referred to as "patient-centered medical homes" or just "medical homes"-- involve integrated care to treat the totality of a patient's needs. This study, published in Arthritis Care and Research, concluded that coordinated care among pharmacists, physiotherapists and primary care physicians resulted in an improved quality of care and life, and also decreased pain and increased function of the affected joint.
[SLIDESHOW: FDA Drug Approval Process]
A large segment of the U.S. population suffers from osteoarthritis – estimated to be nearly 27 million Americans. But osteoarthritis responds well to treatment and lifestyle changes can result in dramatic improvements in both the joint itself and in the quality of life of the patient.
Because of this, osteoarthritis is a good test-case for collaborative care facilities. Rather than seeing a primary care physician, being referred to an orthopedic specialist, who can prescribe exercise, physical therapy, pain medication and recommend seeing a nutritionist, all while managing diabetes with an endocrinologist separate from this process, collaborative care facilities seek to bring all of these services under one roof. A patient may see a primary-care physician, who then refers the patient to a specialist. A staff member of the facility could serve as a "care coordinator," scheduling the other appropriate appointments and work with the patient to ensure that he or she is receiving the appropriate care. A collaborative-care facility would have all of these services within one network, providing a continuum of care that will increase both efficiency and quality of outcomes.
For this particular study, done by researchers from the Collaboration for Outcomes Research and Evaluation in Canada, patients were enrolled in a program that included osteoarthritis screening questionnaires, education, pain medication management, physical therapy exercises and primary care physician communication. Of the 73 patients enrolled in this study, a "significant" number reported greater improvement in overall pain and function compared to those receiving "usual care."
"Finding ways to make the transition from one level of care to another – from acute care to rehab and back again, and to incorporate long-term care where needed – are the advantages" of a system such as this, Dr. Hough remarked, who was not involved in the study. "We need to treat beyond just acute care; we don't want to be repeating the same care 30 days after someone has been discharged from the hospital."
[SLIDESHOW: How to Get The Most of a Physical Therapy Tune-Up]
What is needed, he said, is a system to provide a continuum of care. Conditions requiring chronic care, including COPD, diabetes, osteoarthritis, will benefit the most from such an approach. Dr. Hough added that a coordinated facility may reduce costs and will most likely improve outcomes, as demonstrated in the study.
With such promising results and the hope that collaborative care facilities may, in fact, save money in the long-term, why haven't all facilities begun to make the change?
"There are communities where this style of care will work and other communities where this approach won't be so great," Dr. Hough stated. "In some communities the providers are already structured to work well, where the providers are used to working together, where more coordinated care will be easier to do," he added. "It's not likely that we will find the magic bullet, the one thing that will solve all problems, but we can look for different approaches and perform different experiments anticipating that only some will work."
It’s important, notes Dr. Hough, to publicize these initiatives, and to find out when this approach will work, what are characteristics of those that work and how to replicate them. The Affordable Care Act (also known as Obamacare) encouraged the expansion of these programs as part of a focus on the process of care in a much more comprehensive way.
Unfortunately, many organizations that could be supporting these initiatives are not yet doing so. "Nobody is saying, 'not here, not now, not ever,' but I think many organizations are sitting on the sidelines for now," said Dr. Hough. "A lot of organizations have been burned before, so to speak, and won't have the resources or will to try new approaches."
Dr. Hough concluded: "I look at this as an outsider – we have to find ways to better integrate care. It matters to me, to my mother, to my grandchildren. I have a personal interest in seeing this happen, and I hope it does before we Baby Boomers start having to really lean on the health care system."
Christopher Regal with Dr. Douglas Hough. Telephone Interview. September 7, 2012.
n.p. (30 August 2012). "Collaborative Care Facilitates Therapy Compliance For Patients With Knee Osteoarthritis Improves Function, Pain, And Quality Of Life." Medical News Today. Retrieved from