Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2020; 26(7): 759-769
Published online Feb 21, 2020. doi: 10.3748/wjg.v26.i7.759
Benefits of implementing a rapid access clinic in a high-volume inflammatory bowel disease center: Access, resource utilization and outcomes
Sofia Nene, Lorant Gonczi, Zsuzsanna Kurti, Isabelle Morin, Kelly Chavez, Christine Verdon, Jason Reinglas, Rita Kohen, Talat Bessissow, Waqqas Afif, Gary Wild, Ernest Seidman, Alain Bitton, Peter Laszlo Lakatos
Sofia Nene, Isabelle Morin, Kelly Chavez, Christine Verdon, Jason Reinglas, Rita Kohen, Talat Bessissow, Waqqas Afif, Gary Wild, Ernest Seidman, Alain Bitton, Peter Laszlo Lakatos, Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
Lorant Gonczi, Zsuzsanna Kurti, Peter Laszlo Lakatos, First Department of Medicine, Semmelweis University, Budapest H-1083, Hungary
Author contributions: Nene S and Gonczi L contributed equally to this work. Nene S and Gonczi L were responsible for data analysis, literature overview and drafting the manuscript. Kurti Z, Morin I, Chavez K, Verdon C, Reinglas J, Kohen R, Bessissow T, Afif W, Wild G, Seidman E and Bitton A contributed to the data collection and final analysis and conducted critical review of the manuscript. Lakatos PL was leader of research planning and result interpretation, also he contributed to the statistical planning and data analysis, supervised the manuscript preparation and is acting as guarantor of submission. All authors read and approved the final manuscript including the authorship list.
Institutional review board statement: We hereby certify that the present study design was approved by The Research Ethics Office (Institutional Review Board) of McGill University. Ethics Committee approval was obtained in accordance to ISO protocol, local legal regulations and McGill University Health Center Research Ethics Board guidelines, prior to initiation of this study.
Informed consent statement: Our investigation only included evaluation of clinical data (as approved by the IRB, granting "access to adult health records") and did not required any additional procedures, or influenced health care delivery. As a result, informed consent forms were not required from the subjects for this study.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Peter L Lakatos, AGAF, DSc, FEBG, FRCP (C), MD, Full Professor, Staff Physician, Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital C7-200, 1650 Cedar Avenue, Montreal H3G1A4, Quebec, Canada. peter.lakatos@muhc.mcgill.ca
Received: November 2, 2019
Peer-review started: November 2, 2019
First decision: December 4, 2019
Revised: December 29, 2019
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: February 21, 2020
Abstract
BACKGROUND

Emergency situations in inflammatory bowel diseases (IBD) put significant burden on both the patient and the healthcare system.

AIM

To prospectively measure Quality-of-Care indicators and resource utilization after the implementation of the new rapid access clinic service (RAC) at a tertiary IBD center.

METHODS

Patient access, resource utilization and outcome parameters were collected from consecutive patients contacting the RAC between July 2017 and March 2019 in this observational study. For comparing resource utilization and healthcare costs, emergency department (ED) visits of IBD patients with no access to RAC services were evaluated between January 2018 and January 2019. Time to appointment, diagnostic methods, change in medical therapy, unplanned ED visits, hospitalizations and surgical admissions were calculated and compared.

RESULTS

488 patients (Crohn’s disease: 68.4%/ulcerative colitis: 31.6%) contacted the RAC with a valid medical reason. Median time to visit with an IBD specialist following the index contact was 2 d. Patients had objective clinical and laboratory assessment (C-reactive protein and fecal calprotectin in 91% and 73%). Fast-track colonoscopy/sigmoidoscopy was performed in 24.6% of the patients, while computed tomography/magnetic resonance imaging in only 8.1%. Medical therapy was changed in 54.4%. ED visits within 30 d following the RAC visit occurred in 8.8% (unplanned ED visit rate: 5.9%). Diagnostic procedures and resource utilization at the ED (n = 135 patients) were substantially different compared to RAC users: Abdominal computed tomography was more frequent (65.7%, P < 0.001), coupled with multiple specialist consults, more frequent hospital admission (P < 0.001), higher steroid initiation (P < 0.001). Average medical cost estimates of diagnostic procedures and services per patient was $403 CAD vs $1885 CAD comparing all RAC and ED visits.

CONCLUSION

Implementation of a RAC improved patient care by facilitating easier access to IBD specific medical care, optimized resource utilization and helped avoiding ED visits and subsequent hospitalizations.

Keywords: Crohn’s disease, Ulcerative colitis, Rapid access, Quality-of-care, Emergency department

Core tip: The present study reports a comprehensive analysis of patient access, resource utilization, costs and outcome measures of a newly implemented formal inflammatory bowel diseases (IBD) specific rapid access clinic service compared to usual emergency department visits in IBD patients from a single academic center in North America. Creating a rapid access clinic service for IBD patients is associated with quick patient access, optimized and specific use of diagnostic procedures and services, with similar outcome parameters and lower resource utilization and overall costs compared to regular emergency department visits for IBD patients.