Past, present and future
In the past, healthcare professionals drew on a well-defined, gradually evolving body of biomedical knowledge with fewer therapeutic options. They often had longer, more continuous care-giving relationships with their patients and their families. Today, the near-term prospect of evidence-based, best-practice clinical guidelines coupled with therapy-decision support at the point of service offer the combination of a more scientific and more personalized approach to health and healthcare. While a more standardized approach helps hospitals lower short-term cost, they need to be careful to focus on unwarranted variation in patient care, and preserve the ability of multidisciplinary care teams to deliver personalized healthcare, according to Dr. Miake-Lye. She says, “In adapting techniques from other sectors, it is crucial to remember that all stakeholders in the healthcare sector are involved in new service development for the advancement of patient care, which has profound differences from new product development for manufacturing products.”
In fact, variation — through personalization — is key to making knowledge exchange between the patient/family and the multidisciplinary care team — the unit operation of healthcare delivery — more efficient. Advances in prospective, multiplexed co-analysis of diagnostic testing, patient-reported measures and clinical assessment allow for actionable information on which options for therapy are right for that patient, often referred to as “personalized diagnosis.” In the last ten years of clinical oncology, Dr. Miake-Lye says we have witnessed how better targeted therapies not only reduce costs through the elimination of unnecessary or ineffective treatments, but also by saving lives.
Personalized healthcare delivery
However, Dr. Miake-Lye cautions that providers using diagnostics to better target treatments must not forget the importance of patient involvement and options in healthcare decision making. She promotes what she calls “personalized healthcare delivery,” which embraces prospective as well as retrospective evidence-based medicine provided by a multidisciplinary care team. Already in practice at leading healthcare centers and community hospitals in New England, the care team considers scientifically-informed patient treatment options — early integrated palliative care, clinical trials to which that individual patient is likely to respond, in addition to routine care — and presents them to the patient through a “knowledge-exchange model,” she says. Among other features, shared-decision making means the care team shares the potential benefits and cost to the patient of each treatment option; the multidisciplinary care team along with the patient and his or her family plan therapy together. During this conversation, providers “convey options to the patient and listen to the patient,” says Dr. Miake-Lye. “I was lucky enough to do a project with a breast cancer clinic in which every patient plans their personalized therapy in a meeting with a medical oncologist, a surgical oncologist, a radiation oncologist, and most importantly, two oncology nurses.”
Implementing change
Dr. Miake-Lye recommends health systems with providers that have fallen short in providing patient-centered knowledge exchange start small and focus on one change at a time. “If you try and change every rule, it gets too complicated and you can’t do anything,” she says. “Ask your own healthcare professionals what three things would make the biggest difference in letting them play to their own strengths. Then provide them with a small budget to run a well-scoped pilot project with defined aims. In other words, an experiment that preserves highest quality and safety.” To determine improvements, Dr. Miake-Lye recommends asking patients and care teams a couple of quick questions to assess relative change.
Focusing on the long-term — providing care in a personalized and patient-focused way that rapidly and securely disseminates breakthroughs in patient care — may outweigh other initiatives a health system may be exploring in order to improve short-term efficiency or other demands of healthcare reform, says Dr. Miake-Lye. “There is going to be profound change, but what is really going to impact care? Focusing on the patient and family using a multidisciplinary care team,” she says. While other cost savings efforts are of course warranted, efforts that focus on improving costs through “therapeutically actionable” information will have a larger, sustainable impact that lasts.
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