Managing Hidradenitis Suppurativa With a Multi-Disciplinary Care Team

Introduction: Hidradenitis suppurativa (HS), a chronic, debilitating, and relapsing inflammatory disease of skin, is extremely challenging to manage. Specialized providers are few, and scattered, PCPs do not routinely treat HS, and a comprehensive treatment model is rare. This results in multiple ER visits, hospital admissions and a life-long morbidity.Methods:Integrated care models have revolutionizedcomplex clinical care of chronic illnesses including cancer or mental health. Here, we established a Hidradenitis Multidisciplinary Care Team(H-MDT) – to deliver higher quality, coordinated, collaborative care for patients with HS.Results: A HS-MDT was set up in a large university medical center and results were recorded retrospectively. The steps taken included: 1.   Establish the HS-MDT core organizational structure: wound-care, plastic surgery, dermatology, general/colorectal surgery, infectious -disease, urology, and gynecological-surgery. Inpatient case managers, social workers and physicians/nurses at the extended care facility were included and residents from various disciplines to provide a broader training opportunity. 2.   Delineatefunctional roles and modes of communication between the team members. 3.   ‘Communicate-up’: Secure support from the health system. Seemingly this may not appear as a ‘new-idea’ in the outpatient comprehensive wound centers. However, our results indicate that establishing a wider HS-MDT (including surgical, non-surgical, and support teams) provides a better value-added in all 3 settings: out-patient, inpatient and transitional care: Prompt evaluation and management led to fewer visits; Co-localized specialty clinics, information sharing, near-real-time communication reduced transportation-cost of debilitated patients; Prompt decision-making, strategic treatment planning with coordination of multiple services reduces care-time; Post-hospital care was patient-centered, more efficient, and cost-effective. Discussion: HS-MDT provides better care for patients with a challenging problem. It requires a commitment from providers, patients and the health system. Lessons learned both in the organizational and operations management process will be shared.References: