There is analogy between best outcomes in war and best outcomes in fighting chronic disease. If there is a tough mission in the American military that must be accomplished, most often they call on a special operations team like the Green Berets or the Night Stalkers. These people all get the same basic training as recruits, but once they come together as a team they may train for weeks for the specific mission. They carefully analyze the factors required for success. What transportation will we need? What weapons? What systems will we use? Night-vision? Drones? Satellite images? Then they practice the mission for weeks until it becomes second nature. Those units using that approach are much more successful on these missions than a platoon from a standard infantry division with the usual systems and equipment would be.
It is the same with advanced primary care medical home teams. The members of these units all receive the same general training as any physician, nurse practitioner, pharmacist, physician assistant, nurse, medical assistant, or counselor. It is the team, protocols, and systems that make all the difference. Take the example of chronic cardiometabolic conditions. Special operations teams in that space have produced much better outcomes than those produced in usual care. They achieve a blood pressure control rate of 90% instead of the 44% produced in usual care. They dramatically reduce mortality and costs in heart artery disease. They extend healthier life by eight years in type 2 diabetes. They reduce heart failure hospitalizations by 70%.
Advanced medical home teams have the same focus as the Night Stalkers. They have considered carefully the protocols, measurement techniques, strategies, population health tools, registries, and analytics that must come together to accomplish the mission at the highest level possible. That model systematically supports each member in making the greatest contribution that their training allows. The medical assistant can make certain that every diabetic patient has had an eye exam, microalbumin test, and a diabetic foot exam and that it is all documented in the right place in the electronic medical record. Nurse practitioners using a protocol produce the most effective control of blood pressure, blood sugar, and cholesterol. There is extra time built in for a visit and a focus on helping patients understand their disease and why it is worth their time to do something about it. That produces trusting, long term relationships. That is patient-centered care. Patient and providers are much more satisfied with their interaction.
There is one more analogy. Special operations teams and advanced medical home teams get the job done with fewer casualties. Let’s scale that capacity in medicine.
This is so timely and right on!
Excellent analogy!