Chapter 8 Summary
An Integrated Model fo Healthcare Delivery
Chapter Authors
Steven M Witz - Purdue University
Kenneth J Musselman - Purdue University
Some Commentary
This chapter is a bit too high concept and vague. Most has been cut out except for some unique ideas presented
1. Introduction
This chapter on healthcare engineering looks at 5 barriers to the delivery of healthcare, and proposes an integrated healthcare delivery model to mitigate the problems.
The solution is a move away from ‘event-driven’ healthcare to ‘process-driven’. Change is required at all levels: “provider, care team, organization, and environment”.
2. Barriers & Opportunities
2a. Complexity
Two organizational structures from other industries are proposed a means to reduce complexity in healthcare: microsystems and care platforms.
Microsystems: function as the smallest group of people that can work together, a “minimum replicable unit”. They have shared aims and outcomes. The book does not specify specific examples, but suggests multiple microsystems together would create a a healthcare delivery organization.
Care platforms: function as a ‘unit of service’ that can be standardized in its delivery to provide a group of services to patients with similar needs.
2b. Fragmentation
Care Episodes: microsystems and care platforms can be grouped together, to provide care episodes. Care episodes can be linked together to reduce fragmentation during the management of either an acute or chronic medical condition. “There is neither a generally accepted definition nor a fully implemented application of care episodes”.
The book raises to interesting observations about how to measure care episodes: First, to improve care of complex patients it may be advantageous to measure the outcome of care episodes across multiple conditions rather than view them as isolated. Second, it is important to measure the sucesss of the system based on patient outcomes. Because, this metric focuses quality and care to be directed towards the patient, and not towards the ‘system’..
2c. Acute to Chronic Care
Care Cycle: are a tool to measure multiple care episodes, and for this reason best tuned for chronic care - which has increased to become a primary role in modern medicine.
2d. Healthcare Information and Communications Technology
Paper records have many problems. The book lists difficult with only one person or organization holding the record, the difficulty of tracking and aggregating data.
2e. Linking System Performance and Goals
There is not consensus between groups on the goals of healthcare.
The Institute of Medicine 2001 report suggests six goals: safe, effective, patient centred, timely, efficient, and equitable.
3. Integrated Healthcare Delivery Model
Ultimately creating an integrated healthcare delivery model requires addressing the issues raised above. In addition, it is a continuous balance between individual circumstances and standardized processes; between outcomes for individuals vs populations.