Multidisciplinary approach to LTC gains traction

In 2011, researchers from the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, explored the idea of applying a multidisciplinary approach to long-term care, a setting in which chronic diseases and comorbidities are common. The results reinforced what many have long believed: An integrated, interdisciplinary approach—versus a traditional care model in which physicians visit upon request and in which there was neither coordination of care nor a multifaceted, structured plan of care—delivers better outcomes for residents.

“Compared with the facilities that provided usual care, the intervention facilities had a significantly higher sum score” in 32 quality-of-care indicators, including “communication, delirium, behavior, continence, pain and use of antipsychotic agents,” the researchers wrote. They concluded: “Multidisciplinary integrated care resulted in improved quality of care for elderly people in residential care facilities compared with usual care.”

Such findings come as little surprise to forward-thinking facilities throughout North America and other parts of the world, many of which have been implementing similar models in recent years.

“Nearly all of our residents present with at least two comorbidities,” explains Donna Sroczynski, chief nursing officer at Signature Healthcare. These can include as exacerbation of COPD plus a new hip, for instance, or diabetes plus dementia. “Every facility probably has some level of interdisciplinary care because our regulations call for it,” says Sroczynski,“but just because they have all of the elements doesn’t mean those elements work together in a coordinated way and that is the difference.”

A major point of differentiation is in goal setting. In a true, patient-centered, multidisciplinary approach, goals are set for and with the resident (and often involve his or her family as well) and assignments of duties are made to the various disciplines, services and programs needed to support that goal. Jon Garber, vice president of Health and Operations for Erickson Living, says that an interdisciplinary approach and an interpersonal approach go hand-in-hand. “Our holistic assessment with the resident or guest drives the team. Very early on we ask, ‘What are your goals?’ and in our weekly (for short-term patients) or monthly (for long-term residents) team meetings we discuss how far they’ve come, where they are now and what are we doing to reach the goal.”

Adds Garber: “For our staff, it is not just filling out forms and meeting regulations. It is getting to know the residents and guests.” Although Erickson has on-staff providers who oversee each case, “there isn’t a ‘point person,’ per se. It really is a team approach,” Garber says.

Integral to the multidisciplinary approach is a holistic view of the resident or patient. Sroczynskisays, “This model treats the entire person and family system and considers everything that touches the patient. You are looking at their physical, as well as their emotional, psychological and spiritual welfare.”

For both short- and long-term environments, the execution of this care model typically begins with an assessment and the matching of needs with the clinical programs and specialties of the facility including medicine, pharmacy, social service, psychology, physical therapy, occupational therapy, speech therapy and nutrition services.  

At programs like Signature’s, the assessment reveals “triggers that lead us to the care plan,” Sroczynski explains. Care plan coordinators oversee the plan, but each service and department is responsible for its own discipline. “In a healthy team, everyone is responsible for their own piece and that is what makes it work,” she adds.

Transitioning from a traditional care model to a multidisciplinary approach first requires “carefully assessing the needs of a patient population, defining those needs and defining the responsibilities of each department in meeting those needs,” says Sroczynski. Signature’s operations began their changeover to this model six years ago.

Also essential is the technical infrastructure to allow all services and departments access to a given patient’s complete file. Erickson’s Garber says that the linking of all electronic health records, which took place a little over a year ago, facilitated Erickson’s multidisciplinary approach. “It took time to fully integrate the electronic health records, but pulling through all the different areas so everyone has the same assessment, medication orders and other information helps us be successful.”

Beyond the technical challenges, Sroczynski and Garber say the transition is not easy for staff. “It takes a lot of training, investment and buy-in,” says Bettina Suarez Palacios, vice president of Clinical Operations, Health Services Administration for Erickson.

“We work in an environment that is very regulated, and people can become very focused on the words of the regulations, not their intent, which, we believe, is to provide whole, interdisciplinary quality-of-life care. We need to be less focused on where each of us starts and ends and more focused on what the patient sees,” Sroczynski opines.

Palacios concludes, “It is a worthwhile endeavor in the end, in terms of the outcome to the resident, and the phenomenal satisfaction scores from residents and family members. The results far outweigh any difficulties.”

Gina LaVecchia Ragone is a freelance writer based in Cleveland, Ohio.

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