Becker's Hospital Review

31 Executive Briefing Sponsored by: T wo patients come to a hospital. One is experiencing breathing difficulty, dizziness and incessant bleeding. The other frequently seeks medical care, has heart problems and is experiencing abdominal pain and pronounced swelling in his legs and ankles. A decade ago, both patients would start treatment at point A and go to point B before finally arriving at a specialist, point C. Today, providers are taking a more individualized approach to care and forgoing the A+B=C care model of the past in favor of customizable treatment plans that get to the core of the patient's health problems faster. In the example detailed above, the first patient has diabetes, lung disease and a bleeding disorder. The second patient has cardiac disease, an autoimmune disorder and liver disease. Both patients need surgery. Using an approach based on a solution shop business model, each patient is assigned to a multidisciplinary care team that can ensure each patient is adequately prepared for surgery and that their respective care pathways are tailored to their individual health needs. Solution shop business models are based on three key components: a team structure, a work method and a profit formula. The models are prevalent across multiple industries, as they are customizable and effective in solving unstructured problems. Consulting firms, advertising agencies and research and development organizations all employ solution shop business models, according to a piece from the Christensen Institute. 1 Solution shop business models will serve as the foundation of team-based, customizable approaches to patient care for the next decade, according to Sonya Pease, MD, TeamHealth's Chief Clinical Officer for Anesthesiology. "A surgical solution shop allows each patient to navigate [care] through their multidisciplinary teams for optimization in a way that coordinates their multiple specialists along the common surgical path to a cure," Dr. Pease said. By deploying service-oriented solutions and viewing disease treatment as a team relay race instead of an individual sprint, clinicians can ensure patients with complex challenges receive comprehensive care that supports better outcomes at a lower cost. During her 20-plus years in medicine, Dr. Pease has seen an array of changes. Today, she works with new medications, monitoring devices and equipment that didn't exist when she began her training but are now commonplace. Yet, despite all the advances, there are daily challenges associated with decreasing complications to ensure a high degree of clinical quality and patient safety. Advancements have not yet made treatment completely safe for patients with mild diseases, "which means there is more we need to be doing to continue to improve anesthesia care," Dr. Pease said. Through precision medicine and artificial intelligence, Dr. Pease said anesthesia practices can leverage the surgical solution shop approach and emerging technologies to deliver individualized care designed to treat the complete patient. Individualized care in anesthesiology Anesthesiologists are positioned to be surgical leaders because they can "facilitate collaboration across multiple specialties on care pathways and robust perioperative pre-admit clinics that manage patients based on comorbidities or by the planned surgical procedure," Dr. Pease said. For example, before surgery, a care coordinator or an anesthesiologist meets with a patient to identify and prepare for possible pre-existing conditions, such as anemia or diabetes. The coordinator then walks the patient through the entire procedure, and the care team develops a rehabilitation plan to address procedure-specific goals to enhance recovery. "These types of multidisciplinary intervention decrease perioperative complications and enable patients to be discharged quicker and with fewer readmissions, which is the solution we need in healthcare," Dr. Pease said. Another aspect of individualized care is the emergence of precision medicine. Researchers can now tailor treatments through pharmacogenomics testing, which can give providers a better picture of how a patient will react to a drug. Pharmacogenomics testing can identify the potential for adverse drug reactions as well as the quantity of drugs needed to achieve a desired effect, among other benefits, according to an article in The Lancet. 2 Precision medicine has the potential to vastly change the entire medical field. In 2016, President Barack Obama launched the Precision Medicine Initiative. A research team immediately began to seek out genomic data from at least 1 million U.S. citizens, which would be analyzed to "understand the complex mechanisms underlying a patient's health, disease, or condition, and to better predict which treatments will be most effective," according to a White House fact sheet. 3 Precision medicine has already emerged in several fields of medicine such as cardiovascular, digestive and neurology, but its influence in anesthesia has been fairly limited, according to a study published in Anesthesia & Analgesia. 4 However, precision medicine is still poised to vastly improve aspects of anesthesiology. For example, researchers are exploring how precision medicine-engineered pain management alternatives can be used to curb the opioid epidemic. An FDA presentation honed in on one instance concerning adverse drug reactions. Researchers discovered a small population of Caucasians (7 percent) lacked cytochrome P450 2D6, meaning they could not metabolize codeine or morphine. 5 For these individuals, codeine would provide little pain relief, but would still put them at risk for the adverse events associated with the medication. With this knowledge, clinicians could drop codeine from a patient's Individualized care, AI and the solution shop model: Emerging trends in anesthesiology care

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