“System” does not necessarily mean a specific hospital or healthcare entity, although specialty hospitals can provide comprehensive care. Their singular focus promotes development of best practices across the continuum of care.
“Rheumatology patients often require ongoing care as they cope with a variety of health challenges and complications,” says Mary Kuntz Crow, MD, physician in chief at the Hospital for Special Surgery in New York City. “Collaborative and coordinated clinical care can achieve optimal outcomes. This includes timely care by the most appropriate provider, lower complication rates, fewer readmissions and higher levels of patient satisfaction.”
If this level of specialization is not available, systems become even more important because they can ensure a person’s needs are met even though they cross multiple disciplines.
Dr. Pisetsky cites a person with osteoporotic fractures as an example. The orthopedic surgeon initially fixes the patient’s fracture. After discharge, however, there may be no clear delineation of who treats the osteoporosis.
“Historically, [fewer] than one patient out of every four with fractures are tested or treated for osteoporosis,” says Dr. Saag. “The data also say that there is a strong benefit from beginning antiresorptive therapy. The establishment of programs such as fracture liaison teams can address many of these issues.”
The importance of systems increases with patient age because an older individual may have four or more comorbidities in addition to those involving the bones or joints. All may need attention for the best musculoskeletal outcome.
Patient-Centered Treatment
Patient-centered treatment was also considered by the Summit. These discussions highlighted such needs as ways to address the goals of both the patient and their family in light of population health goals and the role of the USBJI in creating tools to help patients and their families advocate for themselves.
“Especially in areas where there hasn’t been a push to develop systems for treating joint and bone diseases, patients may have to navigate from provider to provider,” says Dr. Pisetsky. “How do you find what is the best care for your disease and then advocate for yourself, not only across the system but also with the individual providers?”
An important aspect of patient-centered care relates to the diversity of the population and differences among patients with respect to gender, as well as racial and ethnic groups. These differences have an impact on many aspects of care, as well as communication among patients, their families and providers. Because the goal of improved musculoskeletal health is lifelong, special programs may be needed for children—especially because childhood is a time of bone growth and development.
Report Sets Forth Priorities
A summary report with recommendations based on the discussions undertaken at the Summit is under development. This report will set out the priorities developed during the meeting and establish a framework for future work. When complete, it will be available through the USBJI’s website at www.usbji.org.