The differences between network medicine and integrated care that you need to know
Network thinking is becoming more popular in healthcare. And it should be, because integrated care has proven to be an effective method to take on the rising healthcare demands and costs. This popularity does have a downside; it has led to an array of synonyms for integrated care: network medicine, coordinated care, managed care, continuity of care, case management, transmural care, patient-centred care, shared care etc. The so-called ‘Bullshit Bingo’. You could say: ‘What does it matter, it all boils down to the same thing anyway?’. Unfortunately it’s not that simple. Aside from the fact that it’s confusing to use different terms to describe the same thing, some of these terms have an entirely different meaning (figure 1). Like network medicine. In this blog we will explain the difference between network medicine and network care.
Figure 1: Elephant
The difference between network medicine and integrated care
It’s not just the Federation of Medical Specialists (Federatie Medisch Specialisten and the Royal Dutch Medical Association (KNMG) that use network medicine as a synonym for integrated care. Medisch Contact wrote that minister Bruins wants to make network medicine – read: integrated care – possible in the Netherlands. The term network medicine is often misused. Because different stakeholders use the terms integrated care and network medicine interchangeably, this will lead to miscommunication. It increases the chance of failing, while ironically good cooperation is the foundation of integrated care.
What is network medicine?
Network medicine is about identifying, preventing and treating diseases. This is done through network analysis. Biological networks can, for example, determine the interaction between proteins. The relationship between illnesses and biological factors is mapped using disease networks. And social networks and transport networks are used to make a model of diseases within the population. Network medicine is a biomedical science that unravels complex, biological networks to improve medical interventions.
What is integrated care?
Integrated care is a coordinated way of working together by a group of care providers to improve the healthcare outcomes for a targeted (sub)population. The care providers are willing to take joint risks when it comes to quality and cost of care. Integrated care is about cooperation between the patient and healthcare providers, between healthcare providers themselves and between healthcare organizations. Integrated care can help unravel complex social networks using models and analyses, to analyze and improve the cooperation.
So network medicine and integrated care are completely different disciplines. The concrete differences are listed in short in table 1.
Table 1: Network medicine vs. integrated care
You could say network medicine and integrated care are two opposite ends of a spectrum with the human in the middle (see figure 2). On the left the discipline of the network medicine is depicted (biological networks) and on the right that of network healthcare systems (social networks). Networks of cells (consisting of molecules and genetic materials) form the individual and individuals form social networks.
Figure 2: Network medicine versus integrated care
Joint foundation: Systems Biology
Network medicine and integrated care both have their origins in system biology. The principle that the whole is larger than the sum of its parts applies there. To take the human body as an example: it consists – simply put – of organs that consist of tissue that consist of cells in which there is genetic material. Tissue is not an amorphous mass, but a dynamic population of unique cells. The “average” cell doesn’t exist, not even within a population of cells of the same cell type. To gain an overview of the entire thing, one must understand the coordinated integration of all cell types. This can only be done through new technologies and a multidisciplinary approach: a cooperation between biologists, chemists, computer scientists, engineers, mathematicians, physicists and doctors. This way, the complex interaction patterns in the human body become clearer and clearer (see figure 3).
Figure 3: System biology
The average patient doesn’t exist either, not in integrated care nor in network medicine. Clinical research with large groups of patients, like integrated care, takes into account the characteristics of each patient. This patient to patient variation is called ‘stratification’. We can also find this stratification in integrated care. To be able to offer efficient and sound health and social services, we stratify patients into high, increased and low risk groups. Just like biological issues, integrated care is also best solved in a multidisciplinary environment. A patient with multiple chronic diseases will easily have to deal with ten care providers who all have their own role and responsibility within the care process. If they work together in a coordinated way, that increases the accessibility, quality and efficiency of care and patient satisfaction.
Analyze your network
So the human body is a complex, biological network made up of many little parts that execute certain functions jointly. And a healthcare system is a complex social network that consists of people, teams, departments and organizations that all work together. Over the last few years we have come to realize that biological and social networks are hardly random, but are based on organizational interaction principles. This is why we can use models to analyze the underlying interactions and optimize interventions. For example by using an ‘organizational network analysis.’ Network analyses can be used to create an overview of all relationships between people and organizations. A relationship that is or isn’t there, can make a big difference. In more concrete terms: like you need a switch to enable a power cable to make a light light up, you also need to work together within organizations to achieve results. By analyzing your network, you will get an idea of how your organization functions and you can adapt where and if you need to.
Learn how to analyze your network
Network thinking is key in 21st century healthcare, but for it to succeed we need to use it in a consistent way. Let’s stop creating confusion by using incorrect terminology. All it achieves is unwanted ambiguity. And let’s use network analyses to further scientifically substantiate the added value of integrated care. In that respect, we should use network medicine as an example, as scientific research is the foundation. On to evidence based policy making for terms like coordinated care, managed care, continuity of care, case management, transmural care, patient-centred care, shared care etc.!
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