Integrated and patient-centred management of Parkinson's disease: a network model for reshaping chronic neurological care

Bastiaan R Bloem, Emily J Henderson, E Ray Dorsey, Michael S Okun, Njideka Okubadejo, Piu Chan, John Andrejack, Sirwan K L Darweesh, Marten Munneke, Bastiaan R Bloem, Emily J Henderson, E Ray Dorsey, Michael S Okun, Njideka Okubadejo, Piu Chan, John Andrejack, Sirwan K L Darweesh, Marten Munneke

Abstract

Chronic neurological diseases are the leading cause of disability globally. Yet, our health-care systems are not designed to meet the needs of many patients with chronic neurological conditions. Care is fragmented with poor interdisciplinary collaboration and lack of timely access to services and therapies. Furthermore, care is typically reactive, and complex problems are managed inadequately because of a scarcity of disease-specific expertise and insufficient use of non-pharmacological interventions. Treatment plans tend to focus on the disease rather than the individual living with it, and patients are often not involved in clinical decision making. By use of Parkinson's disease as a model condition, we show an integrated care concept with a patient-centred perspective that includes evidence-based solutions to improve health-care delivery for people with chronic neurological conditions. We anticipate that this integrated care model will improve the quality of life for patients, create a positive working environment for health-care professionals, and be affordable.

Copyright © 2020 Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Challenges and strategies for achieving the Quadruple Aim The central goal of health care is to reach the Quadruple Aim (central circle). Six important challenges must be addressed in order to reach this goal (second circle). We also identify four main strategies that can help to address this series of challenges (outer circle). The interplay between these four strategies and six challenges in reaching the Quadruple Aim is complex and multifaceted. For example, patient empowerment helps to achieve a more personalised care delivery, facilitates care delivery close to home, and makes care timelier with an improved patient experience, improved health outcomes, and reduced costs as important results. Similarly, professional empowerment ascertains that patients receive appropriate care, but well-trained clinicians are probably also better able to deploy precision medicine approaches. Each of the four strategies is facilitated by modern technological solutions (appendix p 2).
Figure 2
Figure 2
The home-hub-and-spoke model (A) Illustration of how a centre of expertise (the hub; services shown in light blue) can be coupled to a single spoke (services shown in red), consisting of a neighbouring community hospital (where regional care is delivered by specialist Parkinson's disease doctors), a Parkinson's disease nurse (acting as a personal care manager), and regional community-based professionals. (B) One centre of expertise can support many surrounding community hospitals (multiple spokes). The Parkinson's disease nurses working in the various spokes could collectively form a virtual service desk to provide easy access for patients with Parkinson's disease. The multicoloured circles represent individual patients, and the variations in colours are illustrative for their unique individual presentation and personal needs.

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