New model of health care delivery relies on active participation of patients and caregivers

A new model of care developed for patients at the Myeloma Institute for Research and Therapy at the University of Arkansas for Medical Sciences (UAMS) has led to improved patient experience, lower costs and better patient outcomes.

The model of care featured recently in an online article in the Journal of Participatory Medicine, was developed by Elias Anaissie, M.D., director of supportive care at the Myeloma Institute.

Anaissie and Tara Mink, R.N., the institute's director of quality, wrote that a true patient-doctor partnership has been developed by fostering patient participation in their care and providing treatment almost entirely outside the hospital. Outpatient therapy promotes patient independence and comfort, frees limited hospital capacity for patients in most need of inpatient care and has been shown to reduce costs when compared to hospitalization.

Anaissie believes the model could be applied to other medical conditions with a potential to improve patient outcomes and reduce U.S. health care costs. The article "The Cancer Supportive Care Model: A Patient-Partnered Paradigm Shift in Health Care Delivery" can be found at www.jopm.org.

"The model of health care delivery we've developed at the Myeloma Institute relies on active participation of patients and their caregivers," said Anaissie, a professor of medicine in the UAMS College of Medicine. "Patients who are empowered and fully engaged in their own care have a better experience and outcome."

The institute treats more than 2,250 patients with myeloma annually - more myeloma patients than are treated at any other facility in the country. Less than a decade ago, only a third of patients with multiple myeloma, a cancer of the blood and bone marrow, could expect to live more than five years after being diagnosed. The majority of patients diagnosed today who are treated at the Myeloma Institute can expect to survive more than 10 years.

The Total Therapy program developed by Bart Barlogie, M.D., Ph.D., Myeloma Institute director, includes high-dose chemotherapy followed by transplantation of the patient's own blood stem cells to promote prompt recovery of the patient's immunity.

About 90 percent of these transplants for treatment of myeloma are conducted on an outpatient basis- more than any other academic medical center, according to a report by the University HealthSystem Consortium (UHC).

Anaissie said the outcome of myeloma patients treated in the outpatient setting at the Myeloma Institute has been consistently shown to produce superior survival.

"Arkansas' program is truly unique," said a consortium report in January 2010 comparing the UAMS program to 110 academic medical centers. "Arkansas' percentage of bone marrow transplant outpatients is the highest by far."

Anaissie said patients with a life-threatening condition such as multiple myeloma experience a loss of control over their lives, a feeling often compounded by confinement in a hospital. In contrast, when patients reside at home or in a hotel, their sense of normalcy and control over their lives are restored. The choice of inpatient or outpatient therapy is made through collaboration between the patient and physician, Anaissie said.

"The health care environment can have a significant effect on patient satisfaction and experience. A quieter, friendlier, more personalized environment is more conducive to healing," Anaissie said.

Chemotherapy is delivered at the Outpatient Infusion Center that includes 14 private rooms and 44 treatment chairs. The center provides care to about 140 patients, seven days a week from 7 a.m. to 7 p.m. "The infusion center is critical to the success of our care strategy" Anaissie said.

"Our goal is to empower patients, so they are active participants in and not merely recipients of care," Anaissie said. A variety of strategies are used to achieve this goal including patient and caregiver education and networking, monthly Q&A meetings with Barlogie, patient and caregiver resource centers and patient-initiated quality improvement programs in which patients provide feedback and suggestions to improve the care provided.

Patient partnership in care management extends to input on proposed treatment plans, self-administration of injections and intravenous medications, an open medical record policy and 24-hour online access to test results though the myUAMShealth patient portal.

When patients are discharged home after their recovery, coordination of care continues between Myeloma Institute physicians and patients' local physicians through a phone nurse network.

Patients and caregivers also are invited to network through scheduled educational meetings and support groups at UAMS. The Myeloma Institute has created online myeloma support groups and uses social media to communicate with patients and families about institute news and events.

"The Myeloma Institute supportive care model is a multidisciplinary and integrated care delivery system with continuous interaction between areas of care through constant communication in order to avoid fragmentation of care," Anaissie said.