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Clinical integration is a health care philosophy
centered on creating a network of doctors in each community who depend on each
other and work cooperatively to improve the health of their patients.
How does clinical integration make health care better?
It forces doctors to look critically at how we practice, finding ways to more efficiently and effectively
improve patient care. Participation is voluntary but each physician must agree to work collaboratively with the other
professionals in the network on a comprehensive program for each person under
Take, for example, the diabetic patient. Comprehensive
care for diabetics requires multiple interactions within the health-care system
to address the patient’s needs and slow progression of the disease. Such a plan
includes routine visits to a primary-care physician, consulting with a
nutritionist, and checking in regularly with eye and foot doctors. In an
integrated system, instead of being isolated episodes of care, these are
components of a complete program designed to improve the patient’s health. Each
physician interacting with the patient is responsible for not only following
the program but also sharing all findings with the patient’s other providers.
Clinically integrated systems nationally have shown that their patients with
chronic diseases like diabetes have lower incidences of blindness, kidney
failure and the like, preserving quality of life while keeping health-care
Are all clinically integrated networks the same?
The clinically integrated network in each community is
specifically structured to suit that community. As we strive to establish the
first clinically integrated network in Tompkins County, one of our goals is to
improve local access to health care. When people have to wait lengthy periods
for medical care, they often decide to seek it elsewhere, but when they leave
this community for care that is available locally, our
physicians can no longer control the quality or cost of the care they receive.
Patient care thus becomes fragmented, and timely communication – so crucial in
ensuring safety – often breaks down with out-of-town providers; records are
rarely shared efficiently, which can result in duplication of diagnostic
testing or inadvisable medication prescribing. Cayuga Medical Center is
electronically linked with its physician offices, making the flow of vital
information easy and fast. This minimizes waste, provides a higher quality of
care, and results in better value for our health-care dollars.
Each community is a unique entity, and Ithaca is
certainly no exception. Through the Cayuga Area Physicians Alliance, we have a
collection of doctors who are second to none in terms of education, quality,
and commitment to the health care of Tompkins County. However, in some
disciplines we need additional providers to truly improve access to care. We’re
confident that our clinically integrated network will help the medical center
recruit and retain the numbers of primary care and specialty physicians
required to meet the needs of our population and make out-of-town travel for
health care largely unnecessary.
How do you measure the best value for our health care
It starts with a stable, cohesive network of physicians,
working together to share patient data, implementing evidence-based practice
guidelines adapted for our community, and using the latest technology to
measure clinical outcomes. By conducting ongoing peer-reviewed analyses of
clinical outcomes, we identify areas where quality can be improved. When
quality and safety intersect with efficiency, it equals value for our health
care dollar. In the complex world of health care reform, clinical integration is
our best chance to continually improve and streamline the care of our patients
while addressing the ever-increasing cost of health care for everyone in
Dr. Lloyd Darlow is vice president for
clinical integration at Cayuga Medical Center and president of the Cayuga Area
Physicians Alliance. He is board certified in family medicine and is in
practice with Family Medicine Associates of Ithaca, where he can be reached at