Expanding The Conversation On Population-Based Care
Among the challenges facing hospitals today is care for chronic patients—addressing how to keep them healthy and out of the hospital and serving them once they do arrive.
To look for ways to address the issue, a group of healthcare, technology, and design professionals from HDR Inc. and Texas Women’s University partnered to develop a new care model. The goal was to deliver value-based care to chronic care patients and offer a new framework to support a care-delivery model. The concept—called the population based patient unit (PBPU)—was the topic of discussion during a session at the 2015 Healthcare Design Expo & Conference.
“When you talk to people about population health, they all have a different approach,” said Stephanie Woods, a critical care nurse and associate dean at Texas Women’s University.
Woods says the first step in addressing population health is understanding their common needs, what they’re struggling with from a socioeconomic standpoint, where they access healthcare, and where the opportunities are to improve wellness and quality of life.
She expects technology, including EHRs, health data, and telehealth, will play a key role in helping gather that data and advance care. “Having a telehealth strategy is going to be pivotal to bridge the gap between home and all the other places they access care,” Woods said.
To drive home that point, the panelists, including Betsy Berg, senior healthcare consultant, and Bethany Friedow, architectural researcher, at HDR, walked attendees through the model using a prototypical patient. In the example, the fictional patient was an 84-year-old woman with a four-year history of health failure, making her a high-risk patient. As part of the hospital’s PBPU, this patient’s vitals were being monitored on a daily basis via a wrist device that uploaded data to her EHR, which was reviewed and monitored by a care coordinator. “There’s a seamless trail of data for her now,” Woods said, referring to the use of the telehealth tool.
In the scenario, when the patient’s vital declined over a three-day period, a nurse practitioner from the PBPU called the patient as well as the patient’s daughter, her appointed durable power of attorney. After a telehealth visit with a care provider, the team determined the patient needed to move to the next level of appropriate care, which in this case was coming into the hospital and going directly to the population-based unit in the hospital, where she would be observed by staff members already familiar with her case and medical history.
As the patient’s health continued to decline, staff members and family (both in town and out of town) would hold a telehealth call to decide the next steps, which ultimately led to her being admitted into hospice, where nurses could take care of her until she died at home. “All the care coordination is handled by others,” Woods said. “There’s no additional burden to [the patient].”
Friedow said an important step in the process of developing the new care model was looking to other industries that have undergone significant transformations, including library sciences and banking, to see how these changes might impact service delivery and space needs. For example, financial institutions have had to adjust their systems to meet customers’ expectations for more mobile banking and telecommunication services and less brick-and-mortar locations. Linking that to healthcare, she said this example could help providers on ideas for developing virtual or micro clinics.
While there are plenty of what-ifs left to discover and solve, the speakers summarized their discussion with this message: Healthcare architecture is no longer just about space.