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Comment 1

Many provisions are being done to the affordable care act most of which are trying to demonstrate reducing the cost, which is not proving to be enough. Another approach that is becoming primary is focusing on the overall quality, and coordination of the patients care. By focusing on the overall quality of care, this includes everyone who is involved in the care of the patient. Medical/Health homes are homes that provide patients with a central primary care practice or provider. The homes allow providers to focus on preventative care and chronic care management. This program will also help reduce dependence on specialist and emergency care.
The Patient Protection and Affordable Care Act authorizes who how contracts directly with the state to establish community-based interdisciplinary and interprofessional teams in supporting the patients’ primary care.
The interdisciplinary and interprofessional teams may then decided if medical specialist, nurses, pharmacists, nutritionists, dieticians, social work, behavioral health and mental health providers are necessary for care.
I believe that this can be beneficial to patients and healthcare in the fact that it reduces that amount of emergent and acute care issues. If a patient is coming into one provider for preventative care check with hope to detect symptoms early and treat with a primary doctor avoiding the need to see a specialist reducing the cost to the patient and the healthcare provider. The Patient Protection and Affordable Care Act determines who is eligible for an interdisciplinary team so not everyone will be at the mercy of the team also reducing the cost. The quality of care should remain at the same level the Medical/Health Homes just won’t be utilizing as many providers if the patient does not require them. Not to mention patient will have access to Medical/Health 24/7 interviewees reported that 24/7 access to a care provider is also an essential element of the medical home equation even if only through telephonic or electronic means, helps reduce reliance on emergency rooms and resultant preventable hospitalizations (ANA, 2010).
According to Nester (2016), succeeding in the current care environment can only be possible if inter-professional teams will come together and work as a unit. As such, the inter-disciplinary or interprofessional Practice Model as emphasized in the Institute of Medicine report can be termed as innovative.

Comment 2

One innovative health care delivery model which incorporates an interdisciplinary care delivery team is a systematic approach to the flow of care. First a patient presents with certain symptoms or complaints related to his or her health. There might be positive screenings from tests they have already received related to their symptoms. Following a diagnostic workup, a tentative diagnosis regarding their concern can be made. Following this diagnosis, it might be necessary to send the patient to a medical/surgical bed or ICU. They might require medical or surgical intensive care, or simply be sent home. Each stream follows a different set of procedures and personnel responsible for determining the correct path for each patient. This is advantageous to patient outcomes because it ensures that they receive the optimal treatment for their ailments. Standardizing the process and keeping it organizational will greatly benefit patient outcomes and ensure that there is no delay in care. “Each of these steps potentially involves a myriad of options, each of which is directed by a different specialist. This can sometimes result in care that is not clinically appropriate” (Osarogiagbon et. al, 2016, p. 984). All members of the interdisciplinary team need to communicate with one another, rather than just making care decisions based on individual assertions and collecting data together. This can cause disjunction in critical information, delay treatment, and have adverse effects in patient outcomes. 

Comment 3

As science has advanced to allow for more treatment options and cures for patients, providers have found themselves providing a more distanced type of care. With the distance of care, patient and families have been left less educated of their health status and reason for treatments leaving the patients to not feel as secure or in control of their health (Barry & Edgman-Levitan, 2012). In the Institute of Medicine report called Crossing the Quality Chasm, the IOM attempted to introduce an approach to assist in the reform of health care by explaining patient-centered care (Barry & Edgman-Levitan, 2012). The IOM described patient-centered care as care that is respectful of and responsive to individual patient preferences, needs and values (Barry & Edgman-Levitan, 2012). This care model calls clinicians to work as partners and coaches in a patient’s health care journey rather than as a dictator (Barry & Edgman-Levitan, 2012). Such a care model asks patients and their families to become allies with the health care team in designing, implementing and evaluating medical options (Barry & Edgman-Levitan, 2012). Treatment and interventions must be presented to the patient as an option as they always have a choice, especially when options are deemed to have consequences.

As clinicians relinquish their authority role of decision making and move towards a shared-decision making approach they are more equipped to view the experience through the patient’s eyes (Barry & Edgman-Levitan, 2012). This will allow providers to be more responsive to patient’s needs and treat their patients better. Also, clinicians are able to embrace the ethical principles of autonomy and beneficence with this type of model (Reuben & Tinetti, 2012). Patient centered and shared decision care benefits patients by increasing their knowledge of their disease, allow decisions to be aligned with their values, reduced internal conflict and more inclined for positive outcomes when patients are actively engaged (Barry & Edgman-Levitan, 2012). One of the largest barriers to goal-oriented and shared-decision modeled patient care is that medicine is deeply rooted in a disease-outcome–based rather than asking what patients want; the culture values managing each disease as well as possible according to guidelines (Reuben & Tinetti, 2012).

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