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Integrating care during a global pandemic

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Along with upending our daily routines, the pandemic has forced healthcare leaders to rethink the processes involved in the delivery of care. With COVID-19 case and mortality rates continuing to surge, better integration across the continuum of care and in all care settings is becoming increasingly important. Too often overlooked, the hospital clinical laboratory can play an exceptionally valuable role in a coordinated public health approach that can save lives while reducing costs and minimizing the health system’s overall burden. Senior leadership can further leverage the clinical lab infrastructure to enhance integration in virtually all clinical situations, which in turn will improve both financial and patient outcomes.

The coronavirus pandemic has resulted in the disintegration of many parts of the infrastructure that we rely upon for daily life. Every aspect of daily life has been affected. A quick trip to the grocery store to buy a few items has become an expedition that requires personal protective equipment or an online shopping experience. The usual commute to work via public transportation is now a short walk from the kitchen to the computer desk. Chats once held around the water cooler are initiated while waiting for other attendees to join Zoom meetings. It seems that everything has changed, and much of our once-familiar world has disintegrated.

Healthcare has not been immune to the disintegration associated with the global pandemic. Hospitals have refocused their efforts to meet the needs of patients infected with the coronavirus, and most have temporarily discontinued elective procedures. Healthcare workers have experienced dramatic disruption in their routines and lives as they deal with the epidemic. There are, however, examples of how the pandemic has led to better integration across the continuum of care.

In an article published in the Journal of the American Geriatrics Society,1 Montoya et al. describe a collaborative effort between the University of Michigan Department of Pathology and three local nursing homes. This effort was driven by the need to effectively and proactively identify individuals in the nursing homes who had been infected with the coronavirus that causes COVID-19. The proactive testing required support from the clinical laboratories at the University of Michigan, and positive test results resulted in “cohorting of COVID-19-positive residents; communication regarding testing and results with residents, healthcare professionals, and families; personal protective equipment reeducation and use throughout facilities; and dedicated staffing for infected patients cohorted in a dedicated COVID-19 wing.”

The study authors concluded that “[p]roactive and coordinated steps between nursing home medical directors and administrators, referral hospitals including their laboratories, and local public health officials are necessary to rapidly respond to an outbreak and limit the transmission of COVID-19. This coordinated public health approach may save lives, minimize the burden to the healthcare system, and reduce healthcare costs.”

This example of integration across the continuum of care serves as an example of how the clinical laboratory infrastructure can be leveraged to improve both financial and clinical outcomes. But does it require a pandemic to leverage that infrastructure?

Healthcare in the United States is in transition. Increasingly, services that traditionally have been provided in an acute care setting are migrating to outpatient care, self-care, home care, or care in a skilled nursing facility. This transition can result in disintegration from a data and information perspective. However, as shown in the example noted above, clinical laboratories in hospitals and health systems can be a unifying element. When the same lab serves all of the health system’s providers and sites of care within a given geographic region — rather than having multiple labs serve different providers and sites — patient data is more easily integrated and unified across the entire continuum of care.

To realize that potential, hospitals and healthcare systems must use the sunk costs they have in their clinical laboratories differently. They must embrace new service delivery models to serve physician offices, skilled nursing facilities, and home care agencies. In short, they must change their approach to identifying the value of the hospital clinical laboratory.

To integrate care delivered across the continuum, the clinical laboratory must be viewed as an integral part of the infrastructure and not as a commodity to be delivered by the lowest-cost provider. Without the local delivery of COVID-19 testing in the study cited earlier, it would not have been possible to efficiently isolate new test-positive patients and, therefore, the risk for further spread within the nursing homes would have increased. Without the coordination provided by the clinical laboratory to rapidly alert providers, it is likely that hospitalization and mortality rates would have been considerably higher.

What does it take to use the clinical laboratory to integrate the delivery of care? Much of the infrastructure is already in place. But laboratorians need to think differently about service levels as they address the needs of the physician office, skilled nursing facility, and home care agencies. A one-size-fits-all approach will not work. There are ways in which the needs in the acute care setting actually complement those in the outpatient setting. Making sure that the laboratory is addressing the pain points in both settings can actually drive testing volume, which helps to increase revenue and significantly improve operating margins for the hospital.

The value generated by the health system’s laboratory in the study example can and should be generalized more broadly across the healthcare delivery spectrum, as this typically untapped value can be realized in essentially all clinical situations.

To achieve optimal value, the medical center laboratory, which produces 70% of the objective data that supports medical decisions and influences every patient’s care in nearly every care setting, should be leveraged to move away from the fragmented and inefficient situation depicted below, where multiple laboratories, often from a distance and in a delayed manner, potentially provide conflicting information as the patient moves through the continuum of care.

Categories : Healthcare