The application of patient-centered medical home (PCMH) solutions for patients with inflammatory bowel diseases (IBDs) resulted in less visits to the emergency department, fewer hospitalizations and overall improved quality of life in its first year, according to a presentation made recently at the American College of Gastroenterology Annual Scientific Meeting (ACG 2016).
The presentation was given by Miguel D. Regueiro, MD, a professor of medicine at the University of Pittsburgh Medical Center (UPMC).
“Enrollment of IBD patients in a patient-centered medical home in which there’s a payer-provider model is feasible. There’s a significant improvement in quality of life that we saw in the first year, and saw by a short period of three visits,” Regueiro said in a press release. “There’s a significant decrease in unplanned care in terms of ER and hospitalization.”
The PCMH included 308 patients aged 16 to 50 years with confirmed ulcerative colitis (UC) and Crohn’s disease who held insurance through UPMC. The primary reason for physician visits in the past year had been IBD-related, according to Regueiro.
Before enrolling in PCMH, this group of patients had 322 emergency department visits, with 41.7% of patients having at least one visit. There also were 160 hospitalizations with 30.6% admitted for care.
After one year in the PCMH, there was a 51.9% decrease in emergency department visits for the total cohort (155 visits since enrollment). In patients with at least six months of follow-up, researchers observed a 41% decrease in emergency department visits, and 197 in the year before joining the program compared to 116 after joining. Overall, hospitalizations decreased by 53.1% (160 vs. 75) and 44% for those followed for a minimum of six months (100 vs. 56).
“Our UPMC IBD Total Care includes open access, pathways, remote monitoring, telemedicine and a multidisciplinary approach. Our medical home relies on the gastroenterologist as providing principle care to the whole person and is in collaboration with our insurance company,” Regueiro said.
“We have schedulers … who ask what the patient wants to get out of the visit. Prior to the visit, we meet as a team and quickly huddle to plan the care of that patient and how we are going to integrate the visit,” he added. “We have weekly meetings in which we talk about our patients where we alter the plan based on the patient and their needs.”
Regueiro also showed how quality of life improved for these patients, by 9.1 points (31.2 vs. 40.3) by the end of the first year. Final numbers are expected for presentation in time for Digestive Disease Week 2017 in May.
“Do we have a lot to learn? Yes. There’s a lot we’re still working out,” he said. “Hopefully we will see in the future real change.”
ACG 2016 took place Oct. 14-19 in Las Vegas.
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