Rachael Antone, 1st Lt., USAF, NC, BSN, Family Nurse Practitioner student, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Within a patient care setting, it is common to see nurses, physicians, pharmacists, physical therapists, and nutritionists working in silos. From the patient’s standpoint, there are multiple people coming into the room throughout the hospital stay, and often they give differing, sometimes conflicting, information and guidance. This type of disjointed interaction is known as fragmentation of care.
Having a medical team that cares for a panel of patients allows for greater collaboration among healthcare professionals and better patient outcomes as evidenced and informed by the patient-centered medical home model, the Wagner chronic care model, and the creation of rules for accountable care organizations. Legislation such as the ACA defined and facilitated intercollegiate teams by rewarding high-quality outcomes of care with higher reimbursement.
1. Why might it be difficult to get health professionals to reach a consensus on a policy agenda?
2. Using www.Congress.gov, enter the search term (including the quotation marks) “patient-centered medical home” and perform a search of All Legislation. Scroll to see how many bills have been introduced related to this subject since the 110th Congress (2007–2008). Can you find any evidence in literature searches of a consensus in Congress regarding how to reduce fragmentation of care, improve communications, and improve quality of care?
3. What prompted the current emphasis on intercollegiate teams?
4. To what extent do you think the force of law can change the silo practices of nurses, physicians, pharmacists, and other healthcare providers? Identify other approaches that might be successful in changing the silo practice of healthcare professionals.
5. Other than healthcare professionals, who (individuals and organizations) are stakeholders involved in reducing fragmented care? (Hint: Follow the money.) Which collaborations have the American Medical Association, American Academy of Family Physicians, American Association of Nurse Practitioners, American Academy of Nursing, and American Nurses Association already created regarding patient-centered care? To what extent are the Association of American Medicine Colleges and the American Association of Colleges of Nursing influential in this regard? Give examples.