Who Owns the Patient in an Integrated Care Model?

COPD care teams are comprised of a multitude of disciplines, across a multitude of locations. Each member of the team plays a vital role in patient management.

But who is ultimately responsible for the patient?

When patients get sick, whom should they call? Who initiates the palliative care discussion? Who should be the patient advocate throughout the complex COPD care journey?

The truth is, it can be any team member. But what works best – and how do you choose?

Read our insider insights on patient attribution in an ever-changing healthcare landscape.

Individual treater owning patient care

Traditionally, the ownership model has favored an individual care team member.

Based on numerous insider insights, the choice is often the PCP. The PCP is the one most likely to see the patient on a regular, non-emergency basis. Ownership can also be the domain of subspecialists who periodically see patients about more specific matters.

In many cases, however, the COPD navigator takes ownership. He or she manages the longitudinal process and is well suited to advocate for the patient at every step. The navigator, says Brad Drummond, “becomes the center of the wheel, with all the spokes being the different providers.”

But no single right answer applies to all patients. “A good rule is to take your cue from the patient,” says Drummond. When possible, give them a voice and a degree of ownership over their care by letting them choose. Whether they choose the PCP or someone else, the choice is highly personal.

“Our approach has been to try to understand from the patient’s perspective what they value. We see plenty of patients who have a wonderful relationship with their primary care provider.”

M. Brad Drummond, MD, MHS
Clinical Associate Professor
University of North Carolina School of Medicine’s Division
of Pulmonary Diseases and Critical Care Medicine
Driving patient ownership forward

Individual owners have proven effective. Yet as care moves toward an integrated model, is the forward-thinking solution a team-based ownership model? Many of our insiders say yes.

Treatment team owning patient care

Because seamless integration and collaboration drive better care (and support a reduction in COPD readmissions), team-based ownership models are increasingly gaining favor. 

Growing support 

Rationale for care providers to share in the ownership of a patient case

  • Optimal care delivery requires cross-functional collaboration
  • Input on patient care comes from all at different times
  • Stakeholders across settings are expected to unify as a team around each patient

Click to read the remainder of the article including data from a pilot study.

This article was republished with permission from Philips Respironics. It originally appeared in their COPD Insider online publication.

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