A specialty medical home--providing expert medical care coordinated with attention to social support and mental health--is a promising new approach to patient-centered, cost-effective care for patients with Crohn's disease and ulcerative colitis, according to a special "Future Directions" paper in the May issue of Inflammatory Bowel Diseases, official journal of the Crohn's & Colitis Foundation of America (CCFA). The journal is published byWolters Kluwer.
The inflammatory bowel diseases specialty medical home (IBD SMH) is "a new model of care that places the patient at the center of the medical universe," write Dr. Miguel D. Regueiro and colleagues of University of Pittsburgh Medical Center and UPMC Health Plan. They share their institution's experience with developing a specialty medical home to provide comprehensive care for IBD.
Specialty Medical Home Approach for Coordinated Care of IBD
The "patient-centered medical home" has emerged as a new model to improve coordination of healthcare services while controlling costs. So far, most studies of this approach have focused on primary care settings, with mixed results in terms of patient outcomes and healthcare spending.
But for patients with IBD, most care is provided by gastroenterologists and other specialists. "Clinicians who care for these patients recognize that this population requires specialized and personalized care," Dr. Regueiro and coauthors write.
Created in collaboration between healthcare providers and payers, the IBD SMH focuses on providing "high-quality, comprehensive, cost-effective, patient-centered care" for Crohn's disease and ulcerative colitis. While this approach can potentially improve care for all patients, it focuses on the relatively small group who incur disproportionately high costs. Specialists at UPMC found that 14 percent of patients accounted for nearly half of spending for IBD care.
The IBD SMH seeks to address the high rates of emotional difficulties, pain, and poor social support experienced by these "high utilizers." Dr. Regueiro and colleagues explain that pain, stress, coping problems, anxiety, depression, and fatigue can all affect the disease process in IBD--contributing to worsened inflammation and increased healthcare needs.
In addition to optimizing medical and surgical care, the specialty medical home approach aims to enhance behavioral skills, improve social support, and reduce stress. Care is provided by a team including gastroenterologists and personal nurse coordinators, as well as surgeons, behavioral health and pain specialists, dietitians, and other professionals.
Key aspects of the specialty medical home approach include an IBD Patient Checklist to ensure that all recommended preventive care steps are followed; individualized psychological care, addressing the "brain-gut" connection by which stress, anxiety, and depression can lead to worsening of IBD; optimal approaches to pain management, including evidence-based nondrug approaches; and nutritional support to address the special dietary needs of people with IBD.
Dr. Regueiro and colleagues believe the SMH IBD can provide "patient-centered care that improves the value and quality of the medical experience while reducing cost." They hope their experience will be helpful to other medical centers interested in developing specialty medical homes, for IBD or other chronic diseases requiring specialist care.
But the authors emphasize that many challenges remain in optimizing the care provided by the IBD SMH and demonstrating its benefits in terms of improved patient care and reduced costs. Dr. Regueiro and colleagues conclude, "The future of healthcare will rely on chronic care models that have yet to be realized, and the gastroenterologist will play a central role in the IBD management paradigm of tomorrow."
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