In last week’s post, I was showing you the benefits of coordination and the difficulties of integration but only in terms of organizational models, of course. However, now I believe it’s time to enter another innermost level, the clinical process, and for this reason I want to emphasize that regardless of models, aligning care objectives is the key step to improving clinical outcomes. To illustrate what I mean, I thought of an example. Imagine an emergency doctor responding to a person suffocating and, as it can not be otherwise, his goal should be in reducing the clinical problem and helping the patient to recover his normal breathing as soon as possible. But if it turns out that the patient is a complex chronic, the issue is that the doctor should also bear in mind that his action should be performed by the wagnerian chronicity model: What are the circumstances of this patient? Does he live alone? How many relapses has he had lately? Is there a professional team that takes care of him continuously? Can I contact them? From the answers to these questions will depend that the undertaken actions after diuretics and oxygen, are really effective and that the system holistically is able to improve the quality of life of that person.
For those who are not used with the terminology and with the concepts of chronicity, allow me a brief reminder of the model "Chronic Care Model" attributed to Edward Wagner, Director Emeritus of McColl Centre for Health Care Innovation:
For those who are not used with the terminology and with the concepts of chronicity, allow me a brief reminder of the model "Chronic Care Model" attributed to Edward Wagner, Director Emeritus of McColl Centre for Health Care Innovation:
