Assessing Needs and Resources
The first step in planning for a vascular anomalies multidisciplinary clinic (VA-MDC) is a survey of the needs and resources of the local patient and medical community. Multidisciplinary care can be highly varied and dependent on institutional resources,13,19,20 but there are some key resources that each center should strive to employ. Some are key to successful initiation of a clinic and others that can be added as the clinic and program grow (Table 1). Each group should take into account the current system of care for patients with vascular anomalies within their community and any established referral patterns. Involving key medical providers in the community and specialists helps to smooth the transition to an interdisciplinary team. If resources such as equipment, funding, or administration support currently exist, plans can be made to leverage them for the program or to share burdens where they need to be.
At each of our centers, a critical first step in developing our VA-MDCs was to meet with our institutional leaders to discuss the benefits and financial implications of establishing a VA-MDC. This was crucial to developing a sustainable program model and garnering leadership “buy-in”. In each of our regions, there were not existing comprehensive vascular anomalies programs. Patients were cared for in a heterogeneous manner, based on the specialty to which they were referred. With the help of our administrative partners, we researched the electronic medical record to quantify the number of children cared for in the system with vascular anomalies, the specialties to which they were referred, and the mechanisms by which they were commonly treated. This analysis included imaging, pathology, dermatological, surgical and/or interventional radiology interventions, and medical management. This investigation into the mechanisms by which patients with vascular anomalies were cared for in our system revealed widely fragmented care, care plans that were heavily influenced by which service was initially consulted, and substantial lost revenue from patients being transferred to established vascular anomalies centers despite existing expertise in our system. This transfer of care resulted in lost revenue from hospital-based clinic visits, imaging, minimally-invasive procedures, and surgeries. Ultimately, our analysis demonstrated the need for a VA-MDC in our region and outlined a roadmap for the clinic’s fiscal viability, which garnered support across departments.