A group of hospital administrators at a tertiary care center is interested in optimizing quality-related outcomes, including length of hospitalization and patient functional status for high-risk patients undergoing neurosurgical procedures. Patients at highest risk for poor outcomes include those who are age 65 and have multiple medical comorbidities, including hypertension, diabetes, coronary artery disease, and heart failure. The administrators are considering methods to coordinate care between the attending surgeon and a hospitalist-led, multidisciplinary team. Which of the following team-based approaches is associated with improved quality of care?

Question

A group of hospital administrators at a tertiary care center is interested in optimizing quality-related outcomes, including length of hospitalization and patient functional status for high-risk patients undergoing neurosurgical procedures.  Patients at highest risk for poor outcomes include those who are age >65 and have multiple medical comorbidities, including hypertension, diabetes, coronary artery disease, and heart failure.  The administrators are considering methods to coordinate care between the attending surgeon and a hospitalist-led, multidisciplinary team.  Which of the following team-based approaches is associated with improved quality of care?

Quizplus · Accepted Answer

Explanation: Many adults undergoing inpatient surgery have serious medical comorbidities (eg, coronary artery disease) or risk factors (eg, advanced age) that increase the risk of suboptimal outcomes (eg, extended length of stay). Multispecialty, team-based approaches can facilitate improved outcomes by applying collective expertise to optimize management. Comanagement is a team-based model in which the primary surgeon and a comanaging generalist physician (ie, hospitalist) share responsibility for a patient's care. Comanagement is characterized by the following features: Automatic involvement of the comanaging physician for patients who meet specific criteria (eg, age, high-risk diagnosis). This contrasts with traditional models in which the hospitalist is involved only if the surgeon initiates a consult (Choices C and D). Broad scope of practice for the comanaging physician, who proactively identifies medical conditions that need to be addressed and manages them (eg, writing orders, calling additional consultants as needed). This contrasts with traditional models, in which the hospitalist addresses only concerns identified by the primary surgeon (Choice A). Physician roles and responsibilities are often formally delineated in a written agreement, in contrast to traditional, informal consultation models. Current evidence suggests that comanagement improves specific patient outcomes (eg, length of stay, functional recovery) and quality of care, especially when the comanaging physician operates as part of a multidisciplinary team (eg, including nursing, pharmacy, social work). Educational objective: Comanagement is a team-based model in which a surgeon and a generalist physician (ie, hospitalist) share responsibility for a surgical patient's care. In contrast to traditional consultation models, the hospitalist is often automatically involved in the patient's care and proactively identifies and manages the patient's medical conditions. References: Evaluation of internal medicine physician or multidisciplinary team comanagement of surgical patients and clinical outcomes. (http://www.ncbi.nlm.nih.gov/pubmed/32369179) Surgical comanagement by hospitalists: continued improvement over 5 years. (http://www.ncbi.nlm.nih.gov/pubmed/32118566)

A Group of Hospital Administrators at a Tertiary Care Center