The Problem
Patients can have multiple interacting problems. Time is short. Our challenges are to:

  • Identify relevant problems and treatment approaches with each patient.
  • Communicate effectively within the entire clinical team.
  • Coordinate care across teams and settings.
  • Improve outcomes and save on resources.

What about a universal framework to organize a patient’s diagnoses and treatments?. 

The Simple Idea
Called the Siebens Domain Management Model (SDMM), the simple idea:

  • Is an intuitive, practical clinical model.
  • Provides an easy standard framework for patient care.
  • Organizes a patient’s problems into 4 domains (domain being an area of our health).
  • Uses clinician expertise to determine content.

The Four Domains
A practical model with four domains for clinicians:

  1. Medical/Surgical Issues
  2. Mental Status/Emotions/Coping
  3. Physical Function
  4. Living Environment

Together, these four domains are called the Siebens Domain Management Model (SDMM) (© Hilary C. Siebens 2005).

Each domain has a few sub-domains as listed in outline format on the SDMM Communication Card. This card provides the overall SDMM outline, as applicable to physician History and Physicals, Consultations, or Hospital Course reports. Provide your e-mail address to download the SDMM Communication Card at no charge.

SDMM Communication Card Download


Comments or Questions?

SDMM Benefits - Improved Outcomes Using Fewer Resources

Being consistently well-organized can save time and money.

Using the SDMM, Dr. David Kushner and colleagues at the University of Miami Miller School of Medicine, Department of Physical Medicine and Rehabilitation, reported significant benefits.

In their inpatient rehabilitation hospital team conferences, they:
1) Applied the SDMM to re-organize their discussions, and
2) Focused on barriers to home discharge.

All Stroke Patients

All Geriatric Patients

As result, among the benefits they reported were:

1) Team members became more engaged and real problems were solved,
2) Patients were discharged with better function,
3) More patients were discharged home,
4) Lengths of stay were shorter, and
5) For the stroke group, fewer patients returned back to the acute hospital.

“The Siebens Domain Management Model offers improved care and outcomes because the whole interdisciplinary team is empowered to manage all aspects of current and long-term care,” he said. “It’s an excellent means for managing patient care.”

David S. Kushner, MD
University of Miami Miller School of Medicine
Department of Physical Medicine and Rehabilitation

View the annotated citations of Dr. Kushner’s publications in the References.

The Research
In the last 5 years, research, involving the application and efficacy of the SDMM, has been published. Studies have examined the SDMM in:

  • Rehabilitation research
  • Clinical documentation
  • Team conferences
  • Outpatient care coordination in Parkinson’s disease

Earlier work described its use in emergency department care of frail older adults. Read about this work:

Parkinson's Disease

Hip Fractures


The Feedback
“I learned how to incorporate the SDMM progressively through discussions with Dr. Siebens. Now two years later I continue to actively use this framework in all my patient notes because I think it adds a great deal of value.”

W. Scott McDougal, MD
Walter S. Kerr Jr. Professor of Urology
Harvard Medical School
Chief of Urology, Massachusetts General Hospital, Boston, MA

“After learning about the SDMM and trying it out, I’ve adopted it. You don’t really appreciate what it does until you’ve tried it. I am using the model on a regular basis and it is working well for me. I really do think it has improved my follow-up visits so that I cover everything.”

Mel Glenn, MD
Director of Outpatient & Community Brain Injury Rehabilitation
Spaulding Rehabilitation Hospital, Boston, MA

“I have observed Dr. Siebens develop the Siebens Domain Management Model ever since she taught me its principles during my rehabilitation residency. When I became Department Chair there was no question of bringing the SDMM to our Department as a method to think astutely and efficiently about our patients as well as document our care.

This has been critical for teaching residents, focusing on improving care quality, and addressing reimbursement and documentation requirements. Better yet, with Dr. Siebens’ guidance we introduced it with involvement of attendings, administrative staff, and the rehabilitation team over time and the adoption went smoothly.”

D. Casey Kerrigan, MD, MS
Former Professor and Chair
Department of Physical Medicine and Rehabilitation
University of Virginia, Charlottesville, VA

“We can be running around, doing a lot, however missing the boat all together. It really simplifies to break items down into the SDMM’s four domains. Addressing one issue at a time can help solve other issues simultaneously.”

Karen Connor, RN, PhD, MBA
Health Services Researcher
UCLA & Veterans Affairs Los Angeles, Neurology

“I just reviewed a physiatrist’s consult using your SDMM model. WOW! The documentation is so good. It was more thorough than I usually see. The assessment was comprehensive and identified active issues and those requiring monitoring. This format made the medical necessity for the patient’s rehabilitation clear. Personally, it made me feel that the physician was in touch with what was really going on in the patient.”

Lisa Werner Bazemore
Director of Consulting Services
Fleming-AOD/eRehabData, Washington, DC

“Using the SDMM has really helped me. When used in my documentation, it highlights all of the patient’s issues – medical as well as rehab (cognitive, functional, social, etc). This system allows me to focus more on integrating the key aspects of patient care. And using the framework doesn’t take longer once I had learned it. Also, others in rehab hospital administration like the format as well. They say it shows the need for the hospital stay.”

Kevin Lawrence, MD
Physiatrist, Private Practice
Rancho Cucamonga, CA

“I think it is a great leap forward… Very, very useful and I should think it would be easy to use and easy to adapt to the electronic records that are coming down the road. … The idea would be that the initial database and the progress notes and follow-up visit notes would all be in the format of the four domains.… Anyway, congratulations on a nice piece of thinking…”

The Late David H. Solomon, MD, MACP
Email, 2001, while working at the RAND Corporation

I have read your proposal for organizing patient care through the Domain Management Model with great interest. It is excellent… I think so highly of this program that I would recommend it not only for rehabilitation and geriatric patients, but also for all patients to help them better evaluate their own lives and their progress. If there is anything I can do to promote this proposal personally or professionally, I will be happy to do so.

The Late Rabbi Levi Meier, PhD
Jewish Chaplain
Cedars-Sinai Medical Center, Los Angeles, CA

“After learning to use this model, I’d never go back to the old way.”

"This is great. All these areas influence my surgical decision.”
Oncological surgeon

“It flows very nicely.”
Oncologist (about information on his patient, organized by domains)

“This may take another few minutes for my rehabilitation admission notes, but it is well worth it.”
Rehabilitation faculty physician

“This model really helps me justify who needs inpatient rehabilitation and who doesn’t.”
Physiatrist (rehabilitation doctor)

“This organizes the team conferences which otherwise are free-for-alls.”
Nursing home-based nurse practitioner

“Your team conferences (organized by domains) are the best conferences I’ve ever seen.”
Rehabilitation unit nurse-manager

“It would be really helpful if we got basic information arranged by your domains.”
Prosthetist and Orthotist

“This is wonderful. It’s so simple.”
Community-based case manager


For Patients
The simple practical model is extended to patients with a personal notebook, in which they can keep their essential health information using the same four domains.  Find out more about the Siebens Health Care Notebook.  Updated version available soon.