Can the business world teach medicine about team practice?

November 26, 2000

Rush to find out with new team model of care to treat patients with chronic diseases

Rush-Presbyterian-St. Luke's Medical Center has been awarded a $1.9 million grant to pilot a new system of primary care that will determine whether a team approach to providing health care is effective at managing the care of geriatric patients with complex, chronic diseases. The study, funded by the John A. Hartford Foundation of New York City, is called "Virtual Integrated Practice," or VIP, because it will use team principles and practices that have been employed successfully in the business world and apply them to health care settings. Although teams have been used to some extent in health care, they have never been used extensively because several barriers exist that often prevent teams from being successful.

One barrier to more widespread use of team models in health care has been the traditional hierarchical model of medicine, in which the physician made all decisions. Another barrier has been fee-for-service health care reimbursement, which discourages uncompensated activities such as team meetings. Also, teams were often seen as too time-consuming and unwieldy to help in patient care. The complex health issues presented by the rapid growth of America's elderly population have led doctors to reconsider the usefulness of teams. The VIP model will link patients and their doctors with a team of health professionals using currently available technology such as cellular phones, Palm technology and the Internet.

In current health care settings, patients may not have direct access to social workers, nutritionists, nurse practitioners, occupational therapists or pharmacists since most doctors' offices do not employ, or have ready access to these professionals.

Information and communication technologies will be used to link and coordinate the services of team members working in different locations. "The VIP approach starts with the traditional doctor-patient relationship, but enhances it by building a team of health professionals and others to address patients' needs specific to their skills and expertise," said Dr. Steven Rothschild, a practicing family physician and associate professor of preventive medicine and family medicine at Rush.

"Any doctor who takes care of older adults can quickly identify situations in which patients would benefit from having a dedicated team," said Rothschild, who is also the project director. "Diabetic patients need detailed teaching about nutrition and self-care; patients with physically debilitating illnesses can benefit from rehabilitation and social services to help them remain independent." Rothschild pointed out that the majority of doctors in America just do not have these resources in their offices, and as a result their patients don't have access to these services.

"And, if they do get referred for these services, patients often say that they feel bounced around, having to repeat the same information over and over again, and often receiving recommendations that are in conflict with each other," he said.

Rothschild and his co-investigators, who include Rush University faculty in gerontology, nursing, and health care management, as well as Mather Institute on Aging, plan to train and implement teams in four Chicago practices to improve the health of at least 750 patients with chronic bronchitis, incontinence, or diabetes. Team professionals will select communication systems, such as internet-based medical records, e-mail, or so-called "smart phones," to share clinical information and efficiently deliver services to patients.

"The choice of technology is secondary. After all, today's technology will be outdated in twelve to eighteen months," said David Lindeman, Ph.D., co-principal investigator, and director of the Mather Institute on Aging for the Evanston-based Mather

VIP focuses on the interpersonal dimensions of effective collaboration, even when team members have different employers and never actually meet each other in person.

The Rush researchers will watch closely to see how patients and their doctors react to the new health care teams. In addition, they will carefully measure the cost of the services and their impact on patient health and hospitalization rates. The researchers have set ambitious goals for themselves. "Everyone is looking for a magic bullet for the health care system," notes Dr. Rothschild. "We will show that if health professionals learn the skills to work and communicate as an effective team, that they can save the health system money and improve the care of our sickest patients."
Rush-Presbyterian-St. Luke's Medical Center includes the 809-bed Presbyterian-St. Luke's Hospital; 154-bed Johnston R. Bowman Health Center for the Elderly; Rush University (Rush Medical College, College of Nursing, College of Health Sciences and Graduate College); and seven Rush Institutes providing diagnosis, treatment and research into leading health problems. The medical center is the tertiary hub of the Rush System for Health, a comprehensive healthcare system capable of serving about two million people through its outpatient facilities and five member hospitals.

Mather Institute on Aging is part of Mather LifeWays, a not-for-profit organization committed to promoting lifelong vitality and supporting the potential for growth for individuals as they age. Focusing on the needs of social service, health care, and housing professionals, the Institute conducts local and national training programs through presentations, lecture series and conferences. Mather Institute on Aging convenes representatives from philanthropic, research, education, and public policy organizations to study cutting edge program and policy issues.

The John A. Hartford Foundation of New York has a long history of funding projects in geriatric care. The Foundation is a private philanthropy established in 1929 by John A. Hartford. The Foundation focuses its support on improving the organization and financing of health care and assisting the health care system to accommodate the nation's aging population.

Rush University Medical Center

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