Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA

Interprofessional Healthcare

In a recent Practice Perfect we talked about the trend in healthcare toward Accountable Care Organizations (ACOs). Along with this trend comes another one: Interprofessional Healthcare (IPH). Where ACO’s have significant questions and potential huge problems, the concept of IPH seems to be all positive. As healthcare moves toward increasing interactions and interconnectedness, IPH has the potential to greatly improve the delivery of healthcare, while also decreasing the price tag of medicine in this country.

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Diagnostic Imaging:
Radiographic Interpretation
Robert Christman, DPM, FACPR

What is Interprofessional Healthcare?

The concept of interprofessional healthcare is based off of a team approach to medical care. An interprofessional team is one made up of a group of healthcare providers, each one trained to provide a specific task for a patient. Each member of the team sees a patient. The team members then meet together to conference about the patient’s particular health issue and then provide specific care.

Today's Team Approach – Serial and Asynchronous

Our team approach today is done in a serial fashion, one step after another. It's asynchronous, rather than synchronous, and very inefficientt

Some may ask, "How is this different from the current state of medical practice?" It is, in fact, quite different. Currently, medical care is provided in an asynchronous manner. Let's say, for example, I have a diabetic patient with a foot ulcer. The patient first saw their primary care doctor, who referred the patient to me and an endocrinologist. I receive a consultation request, and the patient has his separate appointment with me. He sees the endocrinologist as a separate appointment. I start treatment and send a referral letter back to the doctor. In the mean time, I've ordered blood work (duplicating what the PCP had already done in their office). During my time with the patient, I decide to refer him to a nutritionist who, during yet another appointment, orders repeat labs to evaluate his nutritional status. If one of we providers wants to communicate with the others, we either send a note or make a phone call, both of which take extra time and expense. This scenario becomes even more complicated if we add more providers to the mix, say a physical therapist and a vascular surgeon. We all know how difficult it is to know exactly what’s happening with our patients with the current asynchronized care process.

It's hard to know where the patient is currently at with today's serial evaluation and treatment model - when does the entire team get together to plan ?

The IPH - Parallel and Synchronous

Now, what if we converted this asynchronized to synchronized healthcare delivery. Here’s how it would look using the above example. The patient is referred to an interprofessional care center. At this center is a team of providers: an endocrinologist, podiatrist, vascular surgeon, physical therapist, cardiologist, nutritionist/diabetes educator, nurse care manager, and prosthetist. A comprehensive intake form has previously been completed by the patient and preadmission labs have been done according to an admission protocol. Each of the pertinent specialists then takes a specified amount of time to examine the patient. After everyone has a chance to evaluate the patient, they gather together and have a conference about the patient and determine the best sequence of treatment as a team.

Personal Experience with Interprofessional Healthcare

Sounds impossible, you say? This form of healthcare delivery actually already exists and has for quite some time. For example, the Joslin Diabetes Center in Boston uses this interprofessional model in caring for their patients.

I have personal experience with two interprofessional programs. The first was during my residency, when I spent one month at the Children’s’ National Medical Center in Washington D.C. I was lucky enough to see their Spina Bifida clinic in action. Patients came in for a full morning clinic, during which time various providers (prosthetics, orthopedics, general surgery, medicine, and others) rotated through the clinic, eventually seeing all the patients. At the end, the providers conferenced in person, discussing the various patient problems and concerns, determining as a team the plan for treatment. This was a fantastic experience for me as a resident, and I was able to witness the highest quality healthcare.

My second experience is currently ongoing. At Western University, we have formed the Western Diabetes Institute Interprofessional Provider Unit under the leadership of our medicine and endocrinology team. We at the College of Podiatric Medicine are also involved. This team consists of the following providers: Endocrinology, Nephrology, Podiatry, Dentistry, Optometry, Cardiology, Nursing, and Physical Therapy. As above, we each meet with the patients and have a collaborative conference at the end of the clinic. We then provide a comprehensive set of recommendations to the referring provider.