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.