News and Highlights

August 2014

The Doctor as Quarterback

Suggestions from the frontline for improving patient care coordination

 

Matthew Press, MD, MSc
Dr. Matthew Press

“As a general internist, I often serve as the quarterback for my patients’ care—helping them navigate the system, advocating on their behalf, and coordinating their evaluation and treatment,” writes Matthew J. Press, MD, MSc, Assistant Professor of Healthcare Policy and Research and the Nanette Laitman Clinical Scholar in Quality of Care Research, in an August 7, 2014 Perspective article in The New England Journal of Medicine.

Sometimes this coordination can become extremely complex, involving communications with several specialists and family members, in addition to with the patient. Dr. Press kept track of the tasks involved in coordinating one patient’s care and created an “instant replay” to chronicle those tasks.

“Care coordination is now a high priority in health care and is the backbone of new models of care, such as accountable care organizations, that aim to improve quality and reduce costs,” writes Dr. Press. “But it remains an abstract concept to many people who are not on the front lines of clinical care, as well as to some on the front lines who lack (or don’t want to have) the quarterback’s view of the field. In replaying the highlights, we can learn some important lessons about care coordination.”

The first lesson is that care coordination is foremost a patient-safety issue. “Patients can be harmed when the many moving parts of their care are out of sync, and we owe it to patients to protect them from this type of medical error,” writes Dr. Press.

The second lesson is that we need to update the way we view teamwork in health care. “Given changes in the way health care is delivered and financed, teamwork today must encompass multiple clinical settings, where team members might not see or know each other,” explains Dr. Press. Overcoming the challenges of teamwork spanning health care settings “requires a system designed to support and facilitate collaboration,” writes Dr. Press.

In his article, Dr. Press tells the story of how he was able to coordinate the very complex care for a patient of his, “Mr. K.,” over an 80-day period—care that included 12 clinicians, 5 procedures, and 11 office visits “I was able to play the role I did in Mr. K.’s care largely because, as a clinician-researcher, I had a patient panel about one tenth the size of the average primary care panel,” he writes. “The goal should be to make coordination and collaboration feasible for full-time clinicians, too.”

Dr. Press stresses that for teamwork to be effective across care settings, it is essential for clinicians to have relationships with one another so they can more easily communicate. While he did not have relationships with most of Mr. K.’s other clinicians when his care began, he reached out to them early and often to establish connections. He believes that these connections instilled a sense of mutual accountability.

“Part of my job as quarterback is to make sure the other players know where the ball is and what routes each player is running, writes Dr. Press. “But everyone has to come to the huddle willingly.”

Update

An August 16, 2014 article in The New York Times, "Medicare to Start Paying Doctors Who Coordinate Needs of Chronically Ill Patients," prominently features Dr. Press and his N Engl J Med article.


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