New Interdisciplinary Model Improves Patient Outcomes

Domain management models have long been used in business for team problem solving. The Siebens domain management model (SDMM) is often applied in healthcare settings to improve patient outcomes. The model brings together interdisciplinary team members to review patients’ current and projected progress, and all potential barriers to clinical goals.

David S. Kushner, M.D., clinical associate professor, and Doug Johnson-Greene, Ph.D., professor and Associate Vice Chair, both of the Department of Physical Medicine and Rehabilitation at the University of Miami Miller School of Medicine, recently conducted a comparative study of patient outcomes from before and after the integration of SDMM at HealthSouth Rehabilitation Hospital of Miami. They determined that SDMM was an effective tool to improve patient functional outcomes and decrease length of stay in rehabilitation. Their findings were published in PM&R, the scientific journal of the American Academy of Physical Medicine and Rehabilitation.

SDMM was first introduced in 2011 to HealthSouth Miami, where Kushner is Director of the University of Miami Inpatient Rehabilitation Program and Medical Director for the hospital’s Joint Commission certified stroke program. Under SDMM, each patient’s physician, pharmacist, psychologist, dietitian, therapist, nurse and case manager meet weekly to assess every aspect of the patient’s care, discussing issues affecting functional recovery and discharge to home/community. The model requires each discipline to address:

1. Medical/surgical issues – symptoms, diseases and prevention.
2. Mental status/coping – communication, cognition, emotions and behavioral symptoms.
3. Physical function – basic, intermediate and advanced activities of daily living and mobility.
4. Living environment – physical/accessibility issues, social issues and financial and community resources.

They reviewed stroke patient outcomes from 2010 (pre-SDMM) and 2012, the first full year after the model was instituted at HealthSouth Miami, and compared the results to the national Uniform Data System for Medical Rehabilitation’s patient statistics, which was used as a control group. Kushner and Johnson-Greene discovered that ischemic/hemorrhagic stroke patients under SDMM care had improved functional outcomes and were discharged to the home/community sooner. In addition there were fewer SDMM patients later readmitted to acute care due to complications, and more patients were able to be discharged home rather than to institutional care.

“We saw significant improvement in 2012 within our facility and compared to national data,” Kushner said, “showing that this program is making a difference in improving function and discharge dispositions to home. There was also a decrease in acute care transfers and length of stay was reduced by up to five days.”

In addition to the obvious improvement in patient results, this study has implications for Medicare reimbursement, which under the Affordable Care Act directly links payment to quality outcomes. Kushner suggests that SDMM could be a tool to maximize inpatient rehabilitation stroke functional outcomes and discharge rates, which ultimately would benefit the patient and healthcare facility.

He also feels the model could be applied to acute care patients with health issues other than stroke in hospital and home/community settings. In 2013, Kushner began reviewing SDMM outcomes in geriatrics. He found similar positive results.

While Kushner admits that SDMM is time consuming for clinicians, the benefits outweigh the drawbacks. “For any patient with a prolonged stay, SDMM offers improved care and outcomes because the whole interdisciplinary team is empowered to manage all aspects of current and long-term care,” he said. “It’s an excellent means for managing patient care.”

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