Harnessing the power of the hub
By Michael Pace
Prior to becoming a patient at the Fixel Center for Neurological Diseases at UF Health, Wayne Phillips’ care lacked continuity. Traveling across town from physician to physician was a common occurrence for Phillips, who was recently diagnosed with Parkinson’s disease.
“My treatment regimen wasn’t very tight,” he said. “It left things open, and I was pretty much on my own.”
One of Phillips’ caretakers recommended he and his wife make the drive from Vero Beach to Gainesville and visit the Fixel Center. He was immediately impressed.
“When we went up to the University of Florida, everything was so neatly packaged,” he said. “They had physical and occupational therapists working with me in one location and established health baselines, tested my gait, worked on my speech, and provided helpful techniques to assist me with my handwriting and other everyday tasks. It was a nice, compact situation.”
Kelly Foote, M.D., and Michael Okun, M.D., co-directors of the Fixel Center and members of the Evelyn F. And William L. McKnight Brain Institute of the University of Florida, have been leading an interdisciplinary service and science hub specialty care model since 2011, and it’s significantly improving the patient experience.
“Someone with Parkinson’s disease is predictably going to need a physician, an occupational therapist, a speech and swallowing specialist, and a neurologist,” said Foote, a professor of neurosurgery in the UF College of Medicine. “Some patients also need a neurosurgeon, a psychiatrist, a psychologist, a nutritionist, a social worker — all the different specialists necessary to get the best possible care.”
Chronic neurological diseases are becoming more prevalent due to an aging population, particularly in Florida. As the number of individuals burdened with these conditions increases, so does the need to treat them more efficiently.
Interdisciplinary care is essential for patients with Parkinson’s disease and other neurological disorders, but getting care from various providers can prove costly, time-consuming and stressful for patients.
“Our model allows us to have all these specialized experts under the same roof,” said Adolfo Ramirez-Zamora, M.D., an associate professor of neurology in the UF College of Medicine. “So when you come to see us, you are seen by an expert in various disciplines during one appointment. It’s all geared toward the patient.”
The hub model facilitates efficient and timely communication between specialists, reduces conflicting care recommendations and allows for multiple concerns to be addressed in a single visit.
“The communication is better because we interact on a regular basis,” said Foote. “Because we share so many patients, we have many conversations. This helps to ensure all treatment is aligned and reduces any confusion on the part of the patient.”
Research opportunities are also enhanced and expanded using the hub model, as patients are given the chance to voluntarily become part of clinical research databases.
With every patient being a potential research participant and the outcomes of therapeutic interventions carefully documented over time, the system fosters the potential for increased understanding of the optimal treatment for Parkinson’s patients. Since 2011, patient enrollment in clinical research at the center has increased by 19.5 percent.
“Most centers like ours only have the clinical component and it is often only one specialty,” said Ramirez-Zamora, director of clinical trials at the Fixel Center. “They may have a very powerful research operation, but it’s not part of the hub. Here, we are all together.”
While the majority of those benefiting from the Fixel Center’s hub model are Parkinson’s patients, the concept has far-reaching implications for other neurological diseases as well.
“Most or all neurological conditions can benefit from it,” said Ramirez-Zamora. “Alzheimer’s disease, multiple sclerosis, ALS (also known as Lou Gehrig’s disease), concussions, muscular dystrophies, even severe headaches and migraines could be treated using this model.”
The hub model has served as inspiration for various facilities and programs across UF Health, specifically the UF Health Neuromedicine Hospital, which opened in December 2017.
“The service and science hub model marries clinical care and research, and we used these principles to guide the construction of the UF Health Neuromedicine Hospital,” said Okun, chair of neurology in the UF College of Medicine and medical director of the Parkinson’s Foundation. “The idea of creating value for the patient while at the same time advancing the science was very appealing to us as we planned the hospital.”
Read more about the hub model in a recent Viewpoint article authored by Foote, Okun and Ramirez-Zamora in the Journal of the American Medical Association Neurology: https://bit.ly/2vJgYbZ.
“For complex diseases, the hub model enhances care and outcomes, convenience, communication, research and teaching,” Foote said. “And the next generation of clinicians are all working with us and learning how to implement it.”