Conference Coverage

IBD medical homes dramatically cut ED visits, hospitalizations

Publish date: October 21, 2016
By
Jim Kling
MDedge News

 

AT ACG 2016

LAS VEGAS – A collaborative care approach to patients with inflammatory bowel disease (IBD) dramatically reduced emergency department visits and hospitalizations and also boosted quality of life.

The IBD patient-centered medical home employs open-access scheduling, remote monitoring, and telemedicine. A patient’s team includes a social worker, a nurse practitioner, a dietitian, a psychiatrist, and other specialists. The gastroenterologist acts as a primary care physician, according to Miguel Regueiro, MD, AGAF, medical director of the IBD Center at the University of Pittsburgh Medical Center, who presented the outcomes at the annual meeting of the American College of Gastroenterology.

Dr. Miguel Regueiro

Dr. Miguel Regueiro

The program led to about a 50% reduction in ED visits and hospitalizations in the first year, though the initial goal had been a far more modest 2% drop. “We thought it would take 3 years to get to this point, but we saw these pretty big changes in 1 year,” said Dr. Regueiro in an interview.

Patients were eligible if at least 25% of their health care expenditures in the prior year were related to Crohn’s disease or ulcerative colitis.

The team enrolled 308 patients in the first year, with 290 remaining by the end of the year. Quality of life, as measured by the Short Inflammatory Bowel Disease Questionnaire, rose from a mean score of 7.1 to 9.1 points by the end of the study. There was a 51.9% decrease in ED visits (322 to 155), and a 53.1% reduction in hospitalizations (160 to 75), compared with the previous year.

Among patients who had been in the program for at least 6 months, ED visits dropped by 47% (197 to 116; P = .001) and hospitalizations dropped by 44% (100 to 56; P less than .005).

Dr. Eamonn M. Quigley

The program is not without its challenges. It took a major commitment from an insurer – in this case, the University of Pittsburgh Medical Center Health Plan. Dr. Regueiro hopes to present cost savings at Digestive Disease Week® next year, and those numbers could sway other insurers to give similar programs a try. “If you could even halve the number of ED visits, you could pay for a gazillion team members,” quipped Eamonn M. Quigley, MD, chief of gastroenterology at Houston Methodist Hospital, who attended the session.

Physicians must also rise to the challenge. “The majority of gastroenterologists wouldn’t want to do this because it puts responsibility on them for the whole patient rather than just the disease,” said Dr. Regueiro.

But that discomfort shouldn’t sway them from making necessary changes. Rising health care costs could force specialists into new roles. “The way I look at it, if we don’t do something like this, the insurance companies will tell us what to do,” said Dr. Regueiro.

Dr. Regueiro is a member of advisory boards for AbbVie, Jansen, Takeda, UCB, and Pfizer. Dr. Quigley reported no conflicts of interest.

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