There are many by-words in contemporary medicine and ever more coming along. “Vertical integration” is one of them, but what exactly does it mean?
It means something that we have been doing at Kartini Clinic since 2000 and something we would like to refine further as we move into the future of care for children with eating disorders. Once, vertical integration was an innovation, now it is becoming standard. Vertical integration is a system of care where, as the patient moves between levels of care, there is a high level of integration of care and caregivers. This requires a unified program under one roof and flies in the face of older systems where patients are hospitalized by one group or team and then parceled out to another team on discharge. Notoriously, non-integrated care by various teams in different locations relies on good communication between those teams and a high level of motivation on the part of the new team to read what the first team wrote in their chart notes. I can tell you from years in medicine that this is absolutely the Achilles heel of medical care and rarely happens the way it should. How many times have you had to explain to a new doctor or therapist why your child is there and what has already been tried in the previous setting? Very commonly medical studies are repeated and lab studies done again because of the difficulty to the hand-off from one system to another. “Vertical integration” solves this problem by linking or following the patient throughout their course of treatment.
For example: at the Kartini Clinic there is no “on-service” “off-service” physician rotation, as is common (even required) at academic centers. Both Kartini doctors (myself and Dr. Moshtael) although we divide the hospital call days between us, are always “on-service”. Patients who are in the hospital meet both doctors and both doctors are aware of all details of their care. But more importantly, a Kartini Clinic family therapist is assigned to any hospital family and follows that family until they leave our outpatient care. Parents also attend parent group throughout their child’s stay with us. Our psychiatric provider, Dr. DeSocio, is the same person who assesses psychiatric need at all levels of care. And we long ago solved the problem of integrating (vertically) hospitalized patients with our day treatment providers by having patients attend a session of group therapy on the DTU unit every day, once they are medically cleared to do so.
The exact same team (doctors, therapists, psychiatric provider, front office staff) follows our patients from first appointment through to outpatient. And where legally possible, our team will skype with patients who have returned to a hometown far away.
This is true vertical integration. It’s the standard of practice and you’ll definitely find it at Kartini Clinic. If you are considering another treatment center, make sure to check that treatment is vertically integrated, from the moment of your first evaluation through inpatient (very important) to day treatment and outpatient. Don't accept any excuses or substitutes!
But as good as we think our integration is, how, dear readers, could we at Kartini Clinic make it better?