by Yvette Rolon,CSW, ACSW, Program Administrator,
New York Weill Cornell Center of New York Presbyterian
Hospital
There have been enormous changes in our healthcare system in the last few years. These changes combined with emerging trends and patterns in healthcare have had an enormous impact on the delivery of services. Healthcare providers are constantly seeking ways to improve services to patients. This climate presents both challenges and opportunities.
One of the opportunities is to reassess practice models and to evaluate if current practices are: efficient, effective, meeting the needs of clients/patients, responsive to current trends such as shortening lengths of stay, and the increased penetration of managed care. The social workers at a large New York hospital began to look at some of these trends and evaluate staff deployment. Most staff were assigned to work in a specific geographical location i.e., a specific inpatient unit or clinic, with a few exceptions where there was continuity of care based on diagnosis.
Definitions
A geographical model of care is site specific and random. The focus of service delivery is on the location of the patient, which defines and limits the scope of service he/she will receive. In this model a patient will randomly see a service provider depending on the clinic day or the floor unit they are admitted to with little opportunity to develop an ongoing relationship with them. The interdisciplinary staff in the ambulatory setting or on the inpatient unit will treat that patient only for a discrete episode of care. It is not uncommon for patients to be transferred to different units during an admission; this results in multiple care providers as the patient is transferred. This emphasis on the geographic location of the patient promotes episodic care. Though there is a growing trend for hospitals to try to cluster patients, most care still seems to be provided using a geographical model.
One definition of a continuity of care
model developed by Sona Euster. ACSW, is that it is a comprehensive vehicle
for the delivery of health care service, with three major components. These
components are:
Rationale for a Continuity of Care
Model
Despite the enormous fiscal constraints most hospital staff work under, cost is not an obstacle to developing a continuity of care model because it can be budget neutral. The greatest investments must be in developing staff and institutional buy-in and staff training. This investment is offset by the payoff of staff’s increased sense of team, increased cohesiveness and decrease in duplication of services. Staff can develop ownership and ensure a successful transition by being involved in the development of and training for the new model.
The use of a continuity of care model is cost effective as it improves the delivery of services by increasing efficiency. As a result of limiting the number of social workers involved with patients and families, there is a decrease in duplication of services. One social worker establishes a relationship with a family in a planned way rather than during a crisis period for the family, such as a hospital admission. Prior to the introduction of the continuity model, families were involved with multiple social workers, each trying to learn the family history, conduct an assessment and develop a plan for intervention.
The Blues are the parents of three boys, Tom, James, and Ed, with multiple medical diagnoses which include: allergies and respiratory problems, Tom has cystic fibrosis, two of the children have seizure disorders, one of the children is obese, and one is a diabetic. These children receive all of their medical care at one hospital. They are followed in the Pediatric Primary Care Center as well as in the Asthma-Allergy Center, GI Clinic, Neurology Clinic, Metabolism and Diabetes clinic. This family is typical of high use consumers with chronic illness. Prior to implementing the continuity of care model, this family was routinely seen by five social workers managing the indicated ambulatory areas as well as inpatient social workers when the children were hospitalized.
Ms. Purple the mother of Sally, a teenager with a rare degenerative neurological disorder, asthma, and seizures and is blind, had a similar situation. These families and others like them were often frustrated and puzzled about who to call for assistance because of the number of healthcare providers, including social workers, that were involved with them. Since the implementation of a continuity model, both of these families have one social worker who follows them as they navigate the continuum of care. Interdisciplinary collaboration is also facilitated as there is a single identified social worker to interact with whether it be about preadmission issues, discharge planning or management in the community. Both internal and external customer satisfaction have increased.
The social workers begin to develop mastery and an expert understanding of the biopsychosocial needs of the patient in the continuum of care, as they work with specific disease clusters. They develop knowledge of and linkages to important resources and are able to anticipate and plan for patient and families’ needs. One effect of the implementation of a continuity model has been an increase in support and education groups for patients’ families in the pediatric areas. Social work staff has expressed increased role satisfaction within the continuity model.
The overall response to the continuity
of care model has been positive from patients, interdisciplinary staff
and social workers. The social work department in the hospital has continued
to evaluate other areas where it can be implemented and sees the possibility
of introducing a continuity model in Medicine, a huge but exciting challenge.