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Benefits of implementing a rapid access clinic in a high-volume inflammatory bowel disease center:Access, resource utilization and outcomes

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World Journal of Gastroenterology 2020年第7期26卷 759-769页

作者： 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 Division of Gastroenterology McGill University Health CentreQuebecMontreal H3G1A4Canada First Department of Medicine Semmelweis UniversityBudapest H-1083Hungary

BACKGROUND Emergency situations in inflammatory bowel diseases(IBD)put significant burden on both the patient and the healthcare *** 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 *** Patient access,resource utilization and outcome parameters were collected from consecutive patients contacting the RAC between July 2017 and March 2019 in this observational *** 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 *** to appointment,diagnostic methods,change in medical therapy,unplanned ED visits,hospitalizations and surgical admissions were calculated and *** 488 patients(Crohn’s disease:68.4%/ulcerative colitis:31.6%)contacted the RAC with a valid medical *** time to visit with an IBD specialist following the index contact was 2 *** 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 *** Implementation of a RAC improved patient care by facilitating easier access to IBD specific medical care,optimized resource uti

关键词： Crohn’s disease Ulcerative colitis Rapid access Quality-of-care Emergency department

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