IMPLEMENTING AN IBD MEDICAL HOME IN A COMMUNITY PRACTICE SETTING

ABSTRACT

Introduction Inflammatory Bowel Disease (IBD) homes have been shown in academic settings to improve patient outcomes and decrease health care utilization, resulting in an overall improvement in healthcare quality. Scarce information is available demonstrating their utility in a community practice setting where economic drivers and available resources may differ significantly from academic institutions. The value of these integrated care model homes is often achieved by implementing basic health maintenance initiatives that are lacking with traditional care, which is largely focused on primary disease management. This study seeks to define the baseline compliance of required health maintenance screenings and vaccinations in patients enrolled in a community based IBD Home. Methods We conducted a retrospective analysis of IBD patients enrolling in the IBD Home program of a large community based practice from January 2021 to January 2022. The multidisciplinary team comprised of a gastroenterologist, physician's assistant, dietician, nurse and social worker. No specific education was provided regarding health maintenance requirements to collect baseline compliance. Data collection included patient compliance with bone density scans, dermatologic exams, annual pap smears and receipt of pneumonia, Hepatitis A, Hepatitis B, influenza, and COVID -19 vaccines. Results There were 51 IBD patients enrolled in the IBD Home program with 63% female. of the total cohort, 100% of patients lacked in one or more of the recommended health maintenance guidelines. Specifically, only 27% were current with bone density scans, 29% with routine dermatologic screening, and 16% with PAP smears (HPV vaccination status unknown). Regarding vaccinations, 78% had received influenza, 33% pneumonia, 27% hepatitis A, 43% hepatitis B and 60% for Covid 19 (two doses). Conclusions The analysis of these elements provided key insights into the factors contributing to the low levels of health maintenance compliance noted in these IBD patients. Many community-based gastroenterologists refer patients to their primary care physicians who are not aware of the specific IBD health maintenance guidelines. Further, many gastroenterologists educate patients about the guidelines but lack mechanisms to easily implement the recommendations and to closely monitor patient compliance. Enrolling patients into an integrated IBD medical home provides the resources needed to facilitate heath maintenance issues, although our study illustrates a need to intervene further to effectively impact compliance.