Our Mission

Our mission is to directly address fragmented care through a practical, patient-centered management and tracking framework. The Siebens Domain Management Model™ (SDMM™) provides a complete picture of a patient’s health through a simple, four-domain approach. Through standardization and personalization, SDMM makes improving care easier for patients, providers, and care partners.

SDMM uses a four domain framework to improve patient care: I Medical/Surgical Issues, II Mental Status/Emotions/Coping, III Physical Function, and IV Living Environment © 2018 to improve patient care. Each domain considers the patient from a unique perspective, creating a clearer picture of overall health and care needs. Expert clinicians supply the content, making care planning and delivery easier between patients and providers, within and across health care settings, and over time.


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 Siebens Health Care Notebook.)

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 Siebens Health Care Notebook, 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 SDMM

In 2016, Dr. Siebens heard a lecturer cite a survey of 160 health care industry leaders in which they concurred that clinical standardization is the most important hurdle to integrating health care services. The SDMM™ helps in this need for standardization while focusing on the patient and allowing more personalization of care.  

The SDMM is a simple idea addressing three clinical challenges in patient care that contribute to fragmented care:

  • Patients can have multiple interacting problems

  • Time is always short

  • Multiple providers care for patients using their own discipline’s approach

For health care organizations, these challenges result in fragmentation of care and increasingly risky care when key patient factors are not considered.

What if a universal, simple framework organized a patient’s diagnoses/health topics and their treatments, including social determinants of health?

The Siebens Domain Management Model meets these needs:

  • It’s clinically intuitive and practical

  • It’s an easily-understood standard framework for organizing patient care

  • Patients’ problems/care topics are organized into four domains (each considering the patient from a different perspective)

  • Clinician expertise determines the content within each domain

The Four Domains are:

  • I Medical/Surgical Issues

  • II Mental Status/Emotions/Coping

  • III Physical Function

  • IV Living Environment
    © Hilary C. Siebens MD 2005

Each domain has additional sub-domains.

This concept is now used by clients in medical documentation and to organize both brief and comprehensive team conferences about patients. Studies supporting its use are now published.

The concept also organizes information in the Siebens Health Care Notebook, a single place where patients and families can conveniently keep all essential information needed to manage health care.

See Guidelines for 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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