Effect of Integrated Gastroenterology Specialists in a Primary Care Setting: a Retrospective Cohort Study
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Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Rochester, MN, USA; 2Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Rochester, MN, USA; 3Community Internal Medicine, Department of Medicine, Mayo Clinic Rochester, MN, USA.
BACKGROUND: Gastrointestinal (GI) complaints are common in primary care practices. The patient-centered medical home (PCMH) may improve coordination and collaboration by facilitating coordination across healthcare settings and within the community, enhancing communication between providers, and focusing on quality of care delivery. OBJECTIVE: To investigate the effect of integrated community gastroenterology specialists (ICS-GI) model within a large primary care practice. DESIGN: Retrospective cohort with propensity-matched historic controls. PATIENTS: We identified 265 patients who had a visit with one of our ICS-GI specialists and matched them (1:2) to 530 similar patients seen prior to the implementation of the ICS-GI model. MAIN MEASURES: Frequency of diagnostic testing for GI indications, visits to our outpatient GI referral practice, emergency department and hospital utilization, and time to access of specialty care for the whole population and by GI condition group. KEY RESULTS: Patients seen in our ICS-GI model had similar outpatient care utilization (OR = 1.0, 95% CI 0.7–1.4, p = 0.90), were more likely to have visits in primary care (OR OR=1.5, 95% CI 1.1–2.2, p = 0.02), and were less likely to have visits to our GI outpatient referral practice (OR = 0.3, 95% CI 0.2– 0.7, p < 0.0001). Condition-specific analyses show that all GI conditions experienced decreased visits to the outpatient GI referral practice outside of patients with GI neoplasm. Populations did not differ in emergency department, hospital, or diagnostic utilization. CONCLUSIONS: We observed that an embedded specialist in primary care model is associated with improved care coordination without compromising patient safety. The PCMH could be extended to include subspecialty care. KEY WORDS: patient-centered medical home (PCMH); primary care; gastroenterology; health care utilization; patient-centered care . J Gen Intern Med DOI: 10.1007/s11606-020-06346-4 © Society of General Internal Medicine 2020
Received May 20, 2020 Accepted November 9, 2020
INTRODUCTION
Gastrointestinal (GI) complaints are common in primary care practices, with bowel disorders constituting approximately 8.7% and biliary and liver disorders 8.2% of medical appointments.1 In 2015, over 54.4 million outpatient visits for GI disease occurred across the USA, 3.0 million hospital admissions with a primary GI diagnosis code, and over 500,000 all-cause 30-day readmissions with a primary GI diagnosis code.2 Hepatitis, esophageal disorders, biliary tract disease, abdominal pain, and inflammatory bowel disease were the most expensive (in order).2 Estimated annual healthcare expenditures for GI diseases totaled $135.9 billion in 2015 and expenditures are anticipated to grow.2 Proposed dr
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