7. Systems-Based Practice in Osteopathic Medicine


Osteopathic physicians must understand the larger context and systems of health care and a broader system of linked goals. They will effectively identify and utilize system resources to maximize the health of the individual and the community or population at large. This facilitates improving the individual experience of care, improving the health of populations, and reducing the per capita costs of care. Osteopathic physicians must work well as members and leaders of an interprofessional health care team, identifying areas for improvement to promote care and a culture that enhances quality and patient safety, as well as reduce medical errors, inequities, needless pain and suffering, helplessness, and waste and other inefficiencies.

Required Elements

7.1 Health Systems Awareness

DEFINITION The osteopathic physician must understand health care delivery systems and their associated health care coverage and access, including but not limited to Medicare, Medicaid, managed care, the Veterans Health Administration, formularies, accountable care organizations, and patient-centered medical homes, all of which affect the practice of an osteopathic physician and the care of his/her patients and the community. MEASURED OUTCOMES The osteopathic physician must:
  • know the various types of medical practices and national health care delivery systems, including types of third-party coverage and methods of payment.
  • understand the impact of health care delivery systems on patient care at the national level.
  • identify global issues affecting the health of patients and communities.

7.2 Engage in an Interprofessional Health Care Team for Optimal Patient- and Population-Centered Care

DEFINITION The osteopathic physician must understand the function of the interprofessional health care team and his/her role in the team and also optimize team performance across the health care system for safe, quality patient- and population-centered care. MEASURED OUTCOMES The osteopathic physician must:
  • identify and define the roles of trainees (ie, medical students and residents) and other health care professionals as members of the interprofessional collaborative team.

7.3 Incorporate Considerations of Cost Awareness and Risk-Benefit Analysis in Care

DEFINITION The osteopathic physician must consider how to allocate resources (eg, evaluating value, quality, cost, risk-benefit analysis, potential wastes) in the health care delivery system and incorporate them into the care of patients. MEASURED OUTCOMES The osteopathic physician must:
  • incorporate considerations of cost awareness and risk-benefit analysis in patient- and/or population-based care.
  • make cost-effective decisions in the provision of optimal patient care (eg, request consults effectively, use diagnostic tests judiciously, participate in effective transitions of care) involving health care and resource allocation.

7.4 Advocate for All Patients within the Health Care System

DEFINITION The osteopathic physician must be an advocate for all patients within the health care system. MEASURED OUTCOMES The osteopathic physician must:
  • recognize and work to reduce logistical and systems-based barriers to patient care.

7.5 Improve Health Systems and Patient Safety

DEFINITION The osteopathic physician must understand, advocate for, and apply methods for the evaluation and improvement of patient care systems, with the goal of improving patient safety and quality of care. MEASURED OUTCOMES The osteopathic physician must:
  • identify and use known effective methods for recognizing health system errors, implementing potential system solutions, and improving patient safety and systems of care (eg, error reporting, root cause analysis, training to improve effective transitions of care, best practices for safe prescribing, infection control, disease reporting, disaster management).