mechanisms likely to impact psychosocial care and outcomes include the use of guidelines and protocols that incorporate attention to psychosocial issues; patient support, such as educational, navigation, or case management interventions, to assist patients in having their needs met; and use of information systems to help ensure that providers and patients have the information they need when they need it to facilitate care (Bickell and Young, 2001).

Consistent with these findings, Ouwens and colleagues’ (2005) analysis of systematic reviews of programs for the chronically ill identified program components associated with positive effects on patient-reported outcomes, such as patients’ functional health status, satisfaction with care, and hospitalization. These components included, among others, structured clinical follow-up, often supported by case management; multidisciplinary team care facilitated by regular communication and multidisciplinary care plans in accordance with evidence-based protocols or guidelines; and feedback, reminders, and education for health professionals.

The use of multidisciplinary teams has been found to be effective in reducing mortality and hospitalizations for individuals with heart failure (McAlister et al., 2004). Such teams have been promoted by the British National Health Service and are widely implemented in the United Kingdom. In a comprehensive assessment of the literature and the U.K. experience with multidisciplinary teams in cancer care, however, Fleissig and colleagues (2006:935) conclude that “research showing the effectiveness of MDT [multidisciplinary teams] working is scarce.” Houssami and Sainsbury’s (2006) review of the literature on multidisciplinary approaches for patients with breast cancer found 15 studies, none of which was experimental. While there was some suggestion of better survival, this was attributed to characteristics of the hospital and surgeons (especially patient volume) rather than to the functioning of teams. Psychosocial outcomes were not included in this review.

In addition to the low-tech approach of having on-site nursing staff or other personnel provide care coordination, the high-tech approach of using shared patient records can be used to coordinate patient care. Electronic health records (EHRs) are an important mechanism for sharing patient information among collaborating providers and have been highlighted as one of the essential components of the developing National Health Information Infrastructure (NHII). Although sharing of patient information maintained in paper-based records can take place, the electronic capture and storage of patient information is a more thorough and efficient mechanism for timely access to needed information by the many providers serving a patient. EHRs allow (1) the longitudinal collection of electronic information pertaining to an individual’s health and health care, (2) immediate electronic access—by authorized users only—to person- and population-level



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