Multidisciplinary teams in pediatric otolaryngology have increasingly become a way to deliver quality care that is family-focused while also cutting costs. A panel of experts shared their experiences with integrated craniofacial, aerodigestive, voice, and cochlear implantation teams.
Explore This IssueMarch 2019
Panelists discussed results that were sometimes stunning in terms of cost reduction and the increase in number of patients treated, but said that it’s a process involving improvement over time and emphasized the need for placing the right people in the right roles.
Dana Thompson, MD, head of otorhinolaryngology–head and neck surgery at Lurie Children’s Hospital of Chicago, traced the history of multidisciplinary teams, which began with the first cleft palate team in Lancaster, Pa., in 1938, and really took off after the recognition, in an Institute of Medicine report in the 2000s, that children with special healthcare needs comprised only 18% of cases but 80% of the cost.
The “triple aims” of integrated care teams, Dr. Thompson said, are improving patient care, strengthening the health of populations, and reducing the per capita healthcare cost. The team approach has helped make episodes of stressful childhood illnesses a more tolerable experience, she said. “We really want to support these families in making complex decisions about their children’s care,” she said. “It’s no longer just operating on a patient and saying, ‘I don’t have a complication.’ It’s really bringing the whole team together, understanding what the patient values are, what they expect from their care, and using our best available clinical base of evidence for better outcomes.”
Focus on the Child
At the University of North Carolina⎯Chapel Hill, craniofacial team members include plastic surgery, head and neck surgeons, dentistry and orthodontics, speech professionals, and psychology, said Amelia Drake, MD, professor of otolaryngology–head and neck surgery there. Basic principles of their team management include not only the belief that craniofacial anomalies are best treated with the interdisciplinary approach, but also an emphasis on early treatment, preferably in the first few weeks of life, assistance for the family in adjusting to the birth of a child with an abnormality, family involvement in treatment planning, and long-term outcome monitoring.
The hospital’s former approach to cleft palates used to be focused on aesthetics, but that has changed, she said. “A functional result is considered as important as the aesthetic one,” she said. “Families have support groups. We emphasize the child with the cleft, rather than the cleft.”
A challenge in the field is arranging the resources in a way that best meets the needs of the population, she said, rather than having teams establishing themselves close to one another. “One of my pet peeves is seeing a team rise up right next to an existing team and talk about how [the community is] so underserved,” she said. “Ideally, it’s not about the surgeon, it’s about the patient and making sure that the patients have access to care, not necessarily that every surgeon has an opportunity to have his or her own team.”