Association of Integrated Team-Based Care With Health Care Quality, Utilization, and Cost

From Volume to Value: Prospects and Pitfalls in Organising Integrated Dry Eye Practice Units

“…To be truly patient-centered, an outcomes-based approach, defined beyond medical outcomes, is necessary. In a 'care delivery chain' , remuneration for such outcomes produce the best value for the costs incurred [7,8].…”

“…The "Esther network" [4] and Ed Wagner's chronic disease model [5] are examples of integration across the entire continuum of care, including self and community care, which also cater to the bio psychosocial needs of a person [6]. A study involving 113,452 unique patients evaluated the integration of primary healthcare family practice, internal medicine and geriatric practices, and found superior outcomes in terms of depression screening rates and increased adherence to care, with less emergency visits/admissions [7].The traditional model of healthcare, pivoted around specialized tertiary centers ( Figure 1A), is not optimized for chronic disease care. Traditional healthcare models are largely 'serviced-based' , whereby patients are typically charged for each individual service offered, be it a consultation, procedure or operation.…”

“…To be truly patient-centered, an outcomes-based approach, defined beyond medical outcomes, is necessary. In a 'care delivery chain' , remuneration for such outcomes produce the best value for the costs incurred [7,8].The conformity to streamlined coordinated pathways with minimal variation in care leads to routinisation of processes that increases practice capacity. Coordinated care has been commonly employed in management of diabetes mellitus, involving endocrinologists, ophthalmologists, vascular surgeons, dieticians and podiatrists [9].…”

“…In an open letter from a patient community addressed to ophthalmologists -"Many of us have spent thousands of dollars visiting countless specialists who, after lengthy waiting periods, have often dismissed or ignored our symptoms and clinical picture, offering minimal, outdated, ineffective treatments not specific to our condition". Evidently, there is much room for improvement in achieving patient satisfaction in the management of this condition.Chronic systemic comorbidities commonly compound dry eyes, and this suggests that management under a single traditional medical department may not suffice [7,15]. Patients with dry eye reported a higher frequency of chronic pain syndrome (irritable bowel syndrome, pelvic pain), which is associated with worse ocular and non-ocular pain scores.…”

“Conversational Advice”: A mixed-methods analysis of medical residents’ experiences co-managing primary care patients with behavioral health providers

“…To expand access for patients with BH conditions and improve patient outcomes, health systems are increasingly turning to IBHCs [1,2]. Residency programs that train future primary care physicians also utilize IBHCs to teach residents how to understand and better treat patients with BH conditions.…”