OBJECTIVE:Multidisciplinary clinics (MDCs) aim to provide streamlined, coordinated care and better clinical outcomes for patients requiring access to multiple specialists with unique expertise. Despite broad endorsement in clinical guidelines, no generalizable framework exists for MDC development. METHODS:Drawing on published principles of collaborative care, pediatric-specific considerations, and the authors' collective experience, we propose a seven-step framework (EDUCATE) for establishing effective MDCs: Envision the MDC, Develop the team, Undertake the business proposal, Consolidate support, Activate operations, Team-build/educate/engage, and Expand the mission. RESULTS:The framework was implemented in a pediatric MDC for Prader-Willi syndrome, with measurable improvements in patient access, care coordination, and family experience. CONCLUSIONS:The EDUCATE framework provides a structured, replicable process for building sustainable MDCs in ambulatory care settings.
OBJECTIVE:Health care delivery has undergone a shift from in-person visits to more remote consultations via telehealth. Despite the increasing adoption of telehealth for tertiary medical centers' new patient visits, its impact on subsequent in-person health care utilization has not been widely studied. Our objective was to examine differences in health care services used by patients who established care in-person versus those who initiated care remotely via telehealth. METHODS:We conducted a retrospective review of all patients who established care at one of our three main Mayo Clinic campuses through either an in-person or telemedicine visit between September 1, 2023, and September 30, 2024. We analyzed aggregate data related to downstream in-person services encompassing diagnostic studies, outpatient procedures, surgical procedures (referred to as "surgical yield"), specialist consultations, and follow-up appointments. RESULTS:This study evaluated 252,356 new patient visits, of which 14,915 (5.9%) were performed remotely via telemedicine. Patients who established care in-person had an average of 10.47 subsequent in-person visits. Among patients who initiated care via telemedicine, 62.7% (9,351) later received in-person services, with an average of 16 in-person visits per patient. Surgical yield was higher for patients who started remotely via telehealth and then came on-site, at 29% compared to 16% for those who started with an on-site visit. States bordering the clinic locations had increased percentages of in-person visits compared to states that required patients to travel longer distances. CONCLUSIONS:Patients who established care through an initial telemedicine appointment and then came on-site had more downstream encounters and surgical procedures than those who began in-person. This may be due to the ability to efficiently coordinate multiple appointments within a condensed timeframe, optimizing the planning of on-site visits. Additionally, both patients and providers may selectively utilize telemedicine to identify individuals who would derive the greatest benefit from in-person care.
OBJECTIVE:This study explored how artificial intelligence (AI) technologies support the nondiagnosing/nontreatment roles of allied health workers, examining challenges and risks AI may pose for the workforce and highlighting areas for expansion as AI use grows. METHODS:We conducted 12 interviews with 14 key informants familiar with specific allied health occupations and how AI has been incorporated into their roles. Themes and gaps identified from peer-reviewed and gray literature informed our semi-structured interview guide. We used rapid content analysis to summarize findings from interviews around the following tasks: transcription, medical coding/billing, translation/interpretation, scheduling, communication, and data collection/management. We also summarized findings around ensuring AI literacy. RESULTS:Allied health occupations (typically considered occupations other than physicians, nurses, and dentists) not directly involved in patient diagnosis and treatment have varying levels of interaction with AI. Positive descriptions of AI use in these allied health roles included situations where workforce demand exceeds supply and where AI can be deployed for some routine administrative tasks and may improve job satisfaction by allowing the workforce to focus on more complex and rewarding tasks. AI use was also described positively where it contributed to increased efficiency, for example, in facilitating communications. Because AI can produce biased or erroneous results, cautions about its applications included needing additional staff time to monitor outcomes and avoid negative impacts on patient safety and an organization's operations. Education that contributes to AI literacy across the health workforce is considered critical for its appropriate use. CONCLUSIONS:To date, most allied health workers' jobs with administrative/management roles have not been at risk of replacement by AI. AI's rapidly expanding use, however, combined with the ongoing impacts of provider burnout and financial pressures on health systems, could incentivize increased interest in using AI to compensate for a downsized workforce, including many allied health occupations.
OBJECTIVE:To identify actionable steps from a Veterans Health Administration (VA) Intensive Primary Care (IPC) pilot in five VA sites that primary care teams and health care systems can take to optimize medication regimens in high-risk patients, many of whom have polypharmacy and poor medication adherence. METHODS:We conducted semi-structured, qualitative interviews between 2014 and 2018 with 27 IPC providers and 16 IPC patients. Interviews were analyzed using inductive and deductive approaches to thematic analysis. RESULTS:Patient respondents were an average of 67 years old and more likely to be male (94%), divorced (44%), Black (50%), hypertensive (88%), and have two or more comorbidities (81%). IPC patients and providers described IPC as helping to identify and/or address specific medication adherence barriers that were not adequately understood or addressed in usual primary care. IPC providers' greater understanding of adherence barriers allowed them to optimize patient medication regimens, closing the gap between care provided and patient needs. IPC program elements that enabled care improvements included interdisciplinary care teams, care team accessibility, home visits, and close provider-patient relationships. CONCLUSIONS:Primary care teams can adopt some IPC program elements to help patients optimize medication regimens, such as greater involvement of extended team members, increasing accessibility of care teams through telephone and secure messaging, utilizing home visits for assessment of patients' needs, and developing strong provider-patient relationships.
