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Our Mission

Our mission is to address fragmented and confusing care through a practical, whole person/patient-centered organizing framework. This brings clarity to health care communication facilitating improved care quality. How do we do this? Through the simple user-friendly Siebens Model of Clinical Domain Management, also called the Siebens Domain Management Model (SDMM) or Domain Model. 

The Model consists of a four-domain framework: I Medical/Surgical Issues, II Mental Status/Emotions/Coping, III Physical Function, and IV Living Environment. Each domain considers the individual or patient from a unique perspective, including family and care partners, creating a clearer picture of overall health and care needs. Expert clinicians supply the content. Therefore, the framework makes whole person/patient-centered treatment planning and care delivery easier among teams and over time across inpatient and outpatient settings.

 
 
 
 

Our Story

In over 30 years of providing direct patient care, Dr. Siebens found that complicated care plans and limited time with patients necessitated a new method of organization. She created a four-domain framework to get a clearer picture of her patients’ health, develop an effective treatment plan, and follow changes over time.

Dr. Siebens talking with a research participant (1990).

Dr. Siebens talking with a research participant (1990).

In a trial studying exercise for older hospitalized patients, Dr. Siebens quickly learned that exercising depended on many factors: the patients’ burden of disease, the demands on their coping, what type of movement their bodies tolerated, access to exercising space in their homes or neighborhoods, and availability of encouragement from family and friends. The research also proved the value of an organized binder that included clear instructions and illustrations. (This initial research success evolved over many years into the current Notebook for Wellbeing & Health Care.)

In 1990, when Dr. Siebens was a member of a National Stroke Rehabilitation Guidelines expert panel, she led a group writing the chapter, “Screening for Rehabilitation and Choice of a Setting.” She identified five factors to determine what setting was appropriate for rehabilitation care (medical stability, cognition, functional loss, physical endurance, and social supports). Both the committee and an internationally-known reviewer agreed with her findings. The degree of consensus support indicated to her that this 5-item organizational framework could be refined and much more widely applied to educate and plan care for all patients.

Encouraging feedback from colleagues and patients over the years, along with research evidence, motivated Dr. Siebens to develop the SDMM approach. This includes a personal notebook for patients, the Notebook for Wellbeing & Health Care, organized by the SDMM’s four domains using plain English. Patients, with the help of care partners if needed, can keep their essential health information organized in one place, helping them to manage their care and prepare for doctor visits.

The SDMM’s simple approach helps patients and care teams more efficiently collect, organize, and access information needed to plan and implement good care, whether in a hospital, hospice, or home setting. Documentation is improved, rehabilitation team conferences are more energized and effective, resources are used more efficiently, and even some clinical outcomes are better.

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Learn about the Domain Model (SDMM)

We are familiar with three clinical challenges in patient care:

  • Patients can have multiple interacting problems

  • Time is always short

  • Providers use different ways of organizing patients’ problems and topics 

For patients and health care organizations, these challenges result in care fragmentation among providers and care settings. Risks increase as key patient factors are overlooked.

The Domain Model or Siebens Domain Management Model (SDMM) addresses these needs as it:

  • is a simple person/patient-centered organizing framework

  • applies to any individual with any health condition(s) in any health care setting

  • synthesizes several health models (nursing, biomedical, biopsychosocial, and biopsycho-ecological) and includes social determinants of health

  • is clinically intuitive, practical, and easily understood

  • organizes an individual’s or patients’ strengths, problems, and topics into four domains (each considering the patient from a different perspective)

  • has domain content determined by clinician expertise.

The Four Domains are:

  • I Medical/Surgical Issues

  • II Mental Status/Emotions/Coping

  • III Physical Function

  • IV Living Environment

Each domain has additional sub-domains listed in Table 1 of our open access BMC Health Services Research (2020) article.

The Siebens Domain Management Model is used by clients in medical documentation, in brief and comprehensive team conferences, and in care management. Published studies supporting its use are here.

The SDMM also organizes information in the Notebook for Wellbeing & Health Care, a single safe place where patients and families can conveniently keep all essential information for self-managing their health care.

See Guidelines for Domain Model (SDMM) use here for individual clinicians and for organizations.

“The Model offers improved care and outcomes because the whole interdisciplinary team is empowered to manage all aspects of care… It’s an excellent means for managing patient care.”

–David Kushner MD

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