title: Better together: a community- hospital integrative model of healthcare as a practical solution for providing excellence in endocrinology care in an era of limited resources.
abstract: BACKGROUND
  The demand for endocrinology services is growing worldwide, particularly among minority and underserved populations, mainly due to the rapid global increase of diabetes. The medical education of endocrinologists is a resource consuming process and is mainly hospital-based. Yet, given the chronic nature of endocrine morbidity, the greatest demand for endocrinology services is in the community. However, an isolated endocrinologist cannot cope with the rapid changes in the field. Limited funding of hospital facilities does not allow for the establishment of a freestanding endocrine-center; thus, the Community- Hospital Integrative Model of Healthcare (Co-HIMH) was developed and implemented in an Israeli government hospital and is presented as an approach for achieving excellence in endocrinology care.
  
  
  OBJECTIVE
  To describe the design, function and challenges of the Co-HIMH.
  
  
  METHODS
  Originally, three pillars: 1) the hospital unit as a regional expertise resource, 2) Co-HIMH endocrine providers participating in both community and hospital services, and 3) integrated information flow between health-care providers, supported the integration between hospital and community networks.
  
  
  RESULTS
  The community and hospital endocrine human resources were increased to create attainable and accessible endocrine services in the community and hospital. Collaborative interaction between healthcare providers increased both continuity of care and efficient patient navigation. Endocrine hospital referrals for specialized procedures have grown. Within this area of low socioeconomic status, continued medical endocrine education was conducted introducing state-of-the-art treatments. The essence of these achievements was maintained by continuous training of fellows. During the years that the Co-HIMH operated, it certified 14 % of all endocrinology fellows in Israel. Unresolved issues regarding employee rights and formalization of the Co-HIMH status are significant challenges.
  
  
  CONCLUSIONS
  In the era of limited resources and increased healthcare demand, creative infrastructures are required. This article provides a successful example of a preliminary model and proposes future needed modifications.
authors.affiliation: Endocrinology and Diabetes Unit Hillel Yaffe Medical Center Hadera, Hadera, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Jaffe
authors.affiliation: Viva Research Institute, Jerusalem, Israel.
authors.forename: Aviva
authors.initials: A
authors.lastname: Yoselis
authors.affiliation: Endocrine and Diabetes Service, Meuhedet Health Fund, Ra'anana, Israel.
authors.forename: Liana
authors.initials: L
authors.lastname: Tripto-Shkolnik
keywords: Continuity of care; Diabetes; Endocrinology; Integrative Model of Healthcare