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.