Northwell’s Multidisciplinary Approach to Addressing COVID-19 in Ambulatory Setting Arrianna Mohammed & Ankita Sagar, MD, MPH, FACP
Background
COVID-19 & Multidisciplinary Approach
CARES Program
In healthcare, multidisciplinary approach involves various specialties and healthcare professionals to provide care for patients and their families in a collaborative manner. Over the years, various programs have illustrated the importance of multidisciplinary approach in improving patient outcomes. This summer, the Klar Leadership Program provided me the opportunity to participate in multiple planning meetings leading up to the launch of the CARES program. This experience furthered my understanding of multidisciplinary care and executive leadership from the clinician lens. I also wrote a paper on how this program encompasses the multidisciplinary approach and the historical events that support needing a multidisciplinary approach in the first place.
The outcome studies and experience of the WTC Health Program illustrate the importance of a multidisciplinary approach to complex public health challenges that affect large populations. In March 2020, New York became a global epicenter of the COVID-19 pandemic. Since that time, it has become apparent that COVID-19 may lead to chronic health effects that are still to be fully understood. Like the 9/11 first responders, patients with COVID-19 are experiencing long-term health consequences. This highlights the need for a multidisciplinary approach because: • COVID-19 has a wide symptom presentation, including respiratory, gastrointestinal, neurologic, as well as rheumatologic. • Pediatric patients with COVID-19 infection present differently than adult patients, namely non-respiratory symptoms at presentation. • Patients can initially present with atypical manifestations, such as cardiac health concerns due to severe acute respiratory syndrome caused by the SARS-CoV-2 virus (Atypical Manifestation of COVID-19-Induced Myocarditis). • Mental health has been adversely affected by COVID-19 infection.
Northwell Health decided fairly early that patients with COVID-19 may benefit from a multidisciplinary approach through the development of the novel COVID Ambulatory Resource Support (CARES) program. The highlights of the program include: • Patient Centric: coordinated care for patients with acute symptoms as well as those with chronic progression or lingering symptoms from COVID-19 infection. • Clinician access: assists clinicians in referring patients to clinical experts in different specialties within the Northwell Health system. • Beyond the boundaries: given the large geographic footprint of Northwell Health, the program offers access to clinical experts beyond a single location. • Nurse guided Navigation: through a team of nurse navigators, patients are guided in the process of previsit to post-visit follow up needs. Once patients access this point of contact, the patients undergo a brief assessment of needs and subsequently receive necessary appointments with various specialties for continued care. • Continuum of Learning: CARES assists clinical experts stay up to date on novel treatment, unique case presentations, via the Learning Collaborative. These recurring meetings combine the learning from high impact publications and unique Northwell COVID-19 ambulatory cases. • Clinical Outcomes Research: research is a key part of CARES – upon obtaining consent from patients, Northwell Health Research Consortium will be able to track patients and outcomes to detect patterns of disease progression and recovery. Furthermore, future implications of COVID-19 will be monitored to allow greater understanding of COVID-19 infection sequelae.
Multidisciplinary Care: Historical references In response to the evidence of chronic health challenges in those exposed to 9/11, such as first responders, the World Trade Center (WTC) Health Program was launched in July 11, 2011 under The Zadroga Act. This program accomplished the following: • Developed the WTC Health Registry, a cohort study of 71,000 enrollees. • Illustrated the chronicity of health effects (eg. Asthma, PTSD) • Identified barriers to accessing healthcare services, such as lack of referrals from primary care clinicians, lack of awareness of available programs, and difficulty distinguishing between various programs. • Improved the communication between clinicians by highlighting the importance of referring patients into the WTC program for targeted care. • Streamlined the process of referral by allowing patients to access the program from a centralized location with referrals to appropriate specialties.
Figure 7: Independent CRISPR knockout of CDK4 or CDK6 does not cause dropout in most breast cancer cell lines studied.
Sources: • WTC Program (A qualitative examination of health and health care utilization after the September 11th terror attacks among World Trade Center Health Registry enrollees) https://link.springer.com/content/pdf/10.1186/1471-2458-12-721.pdf • COVID-19 and Multidisciplinary Approach (Atypical Manifestation of COVID-19 Myocarditis) - https://pubmed.ncbi.nlm.nih.gov/32577331/