Integrated Care Models: Optimizing Adult Ambulatory Care in Inflammatory Bowel Disease

Abstract

Background Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is a chronic, complex and unpredictable disease affecting an increasing number of patients worldwide from a young age. Inflammatory bowel disease is associated with multiple comorbidities and complications, requiring ongoing preventative, acute and chronic care. The purpose of this article is to review the literature on outpatient care models used to treat adults with IBD and to gain insight on how to improve quality of care and reduce costs. Methods A comprehensive review of recent literature on PubMed, Scopus and Google Scholar databases about care models used to treat IBD was performed. Key terms included ‘inflammatory bowel disease’, ‘organizational models’, ‘patient care team’ and ‘quality improvement’. Results Studies showed that an integrated care model decreases hospital admissions, IBD-related surgeries and comorbidities of IBD, ultimately decreasing direct and indirect costs of IBD compared with a more traditional patient-physician model. A gastroenterologist-led multidisciplinary team (MDT) involving comprehensive care by IBD nurses, a surgeon, psychologist, dietician, pharmacist, and other members as needed is recommended. Conclusions A holistic approach to IBD care delivered by a MDT with structured monitoring, active follow-up, patient education and prompt access to care improves outcomes for IBD patients. More research is needed on the cost-effectiveness of integrated care models to demonstrate long-term value and secure funding for implementation. Future research should compare integrated models of care and assess patient and physician satisfaction in these models of delivering IBD care.

Crohn’s and Colitis Canada’s 2021 Impact of COVID-19 and Inflammatory Bowel Disease in Canada: Health Care Delivery During the Pandemic and the Future Model of Inflammatory Bowel Disease Care

“…This type of multidisciplinary care delivery is often restricted to large academic centres ( 24–26 ). An integrated model of care in IBD has the potential to improve the quality of care, patient satisfaction, and mental and physical health and to reduce health care costs ( 23 , 27 , 28 ). During the pandemic, multidisciplinary visits have often been continued virtually with the individual seen on same day by different members of the multidisciplinary team in order to make joint treatment decisions ( 29 , 30 ).…”

Leveraging Institutional Support to Build an Integrated Multidisciplinary Care Model in Pediatric Inflammatory Bowel Disease

“…What are the advantages of a multidisciplinary program where each professional contributes to the care of the patient or an interdisciplinary program where professionals also directly interact with shared decisions taking into account the numerous factors contributing to outcomes? Various approaches have been used to determine the best care models from both a healthcare provider and a patient perspective and they unanimously support a “multidisciplinary” process, which in reality often describes an integrated multidisciplinary or interdisciplinary approach to practice [ 32 , 33 , 34 , 35 ]; see [ 36 ] for an in-depth discussion of various multidisciplinary care models. In a study utilizing semistructured interviews with IBD specialists, the consensus was that the ideal model involved “sharing collective expertise in a formalized manner” with interactions between subspecialty providers (i.e., GI physician and psychologist) being of the highest importance [ 32 ].…”

“…In the UK, healthcare providers and patients achieved near unanimous consensus that care should be provided by a multidisciplinary team which meets regularly to discuss appropriate patients [ 34 ]. Another recent systematic review also concluded that an integrated care model incorporating a healthcare team that included a psychologist was the optimum model and is shown to decrease hospital admissions, IBD surgeries, comorbidities, and both direct and indirect costs [ 35 ]. It is clear that a care model that falls along the care spectrum between integrated multidisciplinary (in which providers work side-by-side with real-time meaningful communication/collaboration) and interdisciplinary (in which providers routinely see patients together) is supported by both providers and patients.…”

“…Addressing the financial impact of a program can be the most challenging component of selling your integrated care vision. Approximately half of IBD healthcare providers perceive funding to be the greatest barrier to implementing the ideal care model [ 35 ]. The challenges include the wide variety of evolving reimbursement models, trends towards capitated care and shared risk models, and possible future reimbursement models centered around delivering value to the patient, i.e., improved outcomes at decreased costs.…”

Gastroenterologist Consultation Is Uncommon but Associated with Improved Care Among IBD Patients Presenting to Emergency Departments in Winnipeg Hospitals

“…For those not admitted, it is possible that many could have avoided ED care if an alternate option was available. Provision of emergency care to persons with IBD who do not truly need to be seen in the ED is expensive ( 7 ) and may lead to excess or inappropriate testing or treatment ( 8 ). We have studied the use of ED in Manitoba by persons with IBD using administrative data, however administrative data often does not allow for a granular assessment of the details of the exact reason for the ED visit ( 1 , 7 ).…”