Current Models of Multidisciplinary Care
Two primary models of the modern multidisciplinary clinic (MDC) exist, the virtual or sequential model and the concurrent model.12 Depending on existing clinic structures and resources, there are different benefits to each. The virtual or sequential model (Figure
1) includes a multidisciplinary team discussion about a patient’s case, but patient visits occur separately. The coordinator for the team gathers medical information (frequently with clinical back-up from a nurse or physician) and then schedules patients to see the appropriate providers following the group discussion. In this model, patients are scheduled to see physicians with varying expertise sequentially, with each physician rendering his or her opinion as part of a final treatment plan. Physicians do not see the patient together, but rather communicate with each other between visits and then discuss a comprehensive treatment plan at a follow-up multidisciplinary conference. Benefits to this approach include taking advantage of physician’s existing clinic space and schedules. However, this model can be cumbersome to patients and can lead to disjointed communication.
The concurrent model of multidisciplinary care (Figure 2) treats the clinic as a separate entity from each physician’s primary clinics. Patients see multiple providers within a single day, either together in one room, or sequentially but within the same clinic space and time. The coordinator remains key for gathering the necessary medical information prior to clinic and ensuring appropriate scheduling. In the concurrent model, the team generally reviews patient history, radiologic scans, clinical photos, and pathology at a conference prior to or during the clinic day. Following the in-person visit(s), a treatment plan is developed and then communicated back to the patient and referring physician. Benefits to this model include improved communication and coordination of care, particularly for complex patients with multiple needs. Patients benefit from the ability to see all necessary providers on the same day and often are able to see other supportive providers (e.g. PT/OT, social work, and case managers) who are familiar with vascular anomalies. When providers with different knowledge bases and experiences work together simultaneously, there is also invaluable interprofessional learning and experience sharing. This model is frequently employed in other clinical settings requiring interdisciplinary care, such as hemophilia, bone marrow failure, and neuro-oncology clinics.13 Although an integrated team approach can be achieved with separate office visits and frequent communication, management is more efficient and effective with an integrated approach.14,15 Patients frequently report improved satisfaction and outcomes with the integrated approach, siting the benefit of direct communication with group formation of treatment decisions at a single point in time.16–18 This integrated practice model produces sharing of knowledge and clinical expertise between the different subspecialties, creates a support staff familiar with all aspects of care, and reduces time and financial burden on the patients.
Choosing a model for a multidisciplinary clinic must take into account the needs and resources of the medical community in which is it housed. Benefits to the concurrent model include efficiency for both patients and providers, improved communication between specialists, and knowledge building as a team. However, the virtual or sequential model provides the ability for a multidisciplinary team to function effectively even in the setting of time or space constraints. Regardless of clinic model (sequential vs. concurrent), a multidisciplinary, case-based conference is essential for improving communication and education amongst the team members. Upcoming and prior cases are reviewed with their associated imaging and pathology. This conference typically includes a mixture of case management and educational components. The frequency of team meetings can be adjusted based on the caseload at each center and the availability of team members. A smaller community-based center may be adequately served with quarterly conferences, whereas a busy tertiary center may have weekly vascular anomalies team meetings. Much of the management of vascular anomalies is chronic and semi-elective, but urgent cases will arise, so the team members need to have a system in place for quick and effective communication.