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Originally published October 9, 2024
Last updated October 9, 2024
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Working in silos is often an inefficient health care model. Laryngologist Michael M. Johns, MD, director of the USC Voice Center, part of the USC Caruso Department of Otolaryngology – Head and Neck Surgery and Keck Medicine of USC, explains how the USC Voice Center saw numerous benefits after adopting an interprofessional practice (IPP) model.
Many patients are familiar with the siloed model of health care: A primary care physician sees a patient. The physician then refers the patient to a specialist. That specialist may send the patient to additional providers for other aspects of care. During the course, communication between providers is limited, enabling potential errors, gaps in service or duplicative services. Patients, meanwhile, bear the brunt of multiple appointments, including cost, travel time and the stress of trying to get all providers on the same page to form a united treatment plan.
In IPP, health care professionals collaborate on diagnosis and treatment. Johns explains how this works at the USC Voice Center. “When a patient initially comes to the USC Voice Center, they are seen simultaneously by a laryngologist and a speech-language pathologist. After we do the diagnostic exam, we conference, sometimes with the patient in the room, about what we think we should do based on our collective assessment.”
Another model, multidisciplinary care, is similar but still different, Johns says. With multidisciplinary care, patients have access to numerous specialists. “But interprofessional practice is delivered in a setting where each member of the care team provides their professional opinion and then together develop an assessment and treatment plan.”
In a non-IPP model, a patient making an appointment due to vocal concerns might, over the course of their diagnosis, be seen by a primary care doctor, an otolaryngologist, a speech-language pathologist — or even a voice coach. “Each doctor might write a short prescription or fill out an electronic referral providing limited information, and the patient has to then make a new appointment to see a new specialist on a different day. That fragmentation is where things break down,” Johns says.
IPPs are more common in sports medicine or cancer teams where rehabilitation is often needed. For other practices, like the USC Voice Center, it is also an ideal model.
If an interprofessional practice model is right for your team, it can help maximize both efficacy and efficiency, Johns says.
For patients, the benefits of IPP include both time and cost savings from not having to see multiple providers separately. More importantly, however, patients tend to have added faith in their treatment plan. “Patients are more satisfied because they’re receiving a comprehensive, refined treatment plan for their problem that includes input from all stakeholders,” Johns says. “We have evidence to show that patients understand their treatment plan and overall situation better.”
IPP also motivates patients to follow through with treatment. “When they understand their diagnosis and treatment better, they’re more likely to adhere to their treatment plan — and they end up getting better results,” he says.
Referring physicians like this model, too. “If they’re sending a patient with voice, swallowing or upper airway problems to our center, they don’t have to think about all the specialists their patient needs to see,” Johns says. “They can just send their patient to our center and know that the rest of care is going to happen.”
On the provider end, in addition to eliminating gaps in patient care and improving patient outcomes, IPP lets physicians learn from each other. “During a patient visit, I may ask the patient questions, and then our speech-language pathologist might ask different questions from their perspective. This gives me more information, and we end up with a better diagnosis overall.”
To maximize a treatment plan’s success, members of the care team can also keep each other informed of factors, such as social determinants of health, that can hinder a plan. For instance, if a therapist learns why one part of a plan might be difficult for a patient to follow, they can share that information with the rest of the IPP team, who can adjust the treatment plan to accommodate these challenges. Again, this leads to better outcomes.
Implementing IPP can be hard in the beginning. “These things are easy to talk about but hard to implement,” Johns admits.
Clinicians need to agree to align their schedules — and only if they see benefits. “We want it to be efficient for everyone,” Johns says. This includes ensuring key clinicians are present at appointments but that clinicians who likely aren’t needed aren’t required to be there.
“We’ve developed what we call interprofessional slots,” he explains. “We have four interprofessional slots in each of our half-day clinics, and most new patients end up scheduling for those slots. If we know we’ll be seeing 12 patients, and our speech-language pathologist is going to be needed for eight of those patient visits, then it makes sense for them to attend. If they’re only needed for two patients, however, then it wouldn’t make sense to have that clinician available the whole time. It comes down to scheduling clinics and working with our access center — and communicating appropriately with patients about what to expect when they come to our clinic.”
IPP doesn’t make sense for every situation either. “There are certain specialties that lend themselves more to this model, such as our field, and others that don’t,” he says.
And while IPP is easier to implement in large health systems, where a variety of subspecialists are available, setting up IPP in smaller practices is not prohibitive. “If you are a smaller practice but you see a lot of patients with balance problems, then you might see value in having an audiologist, a vestibular therapist, and otolaryngologist and a neurologist on hand for evaluations,” he says.
Getting the okay from management to switch to IPP can also take work. “The challenge is convincing administration that this model of care is financially better,” Johns says.
In the case of the USC Voice Center, the model has yielded significant benefits in both time and money. “We can actually see more patients in each clinic because we have more clinicians seeing the patient at the same time,” he explains.
He estimates that through IPP, the USC Voice Center can see 25% more patients than it could before. “Because, for instance, when the speech-language pathologist is getting images of a patient’s focal folds,” he says, “I can be seeing another patient in the meantime — and then go back to the first room. Then we can all circle back and connect.”
Finally, because IPP motivates patients to stick with their treatment regimen, this cuts down on no-shows. “We have much more adherence and follow-up, so we don’t have that loss in the pipeline of patients who ‘drip’ out of the health system,” Johns says.
Overall, he suggests more providers consider the model. “When it comes to specialty centers of excellence, we still see the IPP model not being employed as much as it could,” he concludes.
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