Establishing a medical home for patients with inflammatory bowel diseases: a qualitative study
The Patient-Centered Medical Home model has gained popularity in primary care to provide early effective care to patients with chronic conditions. Prior research on specialty medical homes has been cross-sectional and focused on patient outcomes. The objective of this longitudinal qualitative study was to identify best practices in establishing a specialty medical home in Inflammatory Bowel Diseases (IBD Home). The multimethod study included direct observations of multidisciplinary team meetings (30 hours over one year) and in-depth interviews with individual team members (N=11) and referring physicians (N=6) around their participation in the IBD home. All interviews were professionally transcribed verbatim. Two researchers coded transcripts for themes using NVivo software. Weekly team meetings (N=9±3) included behavioral health providers, nurse practitioners, nurses, dietitians, a clinical pharmacist, and clinical coordinators. Physicians referred patients with psychosocial comorbidities to the IBD home. Initially the team enrolled all referred patients. Later, they developed exclusion criteria and a patient complexity score to manage the volume. Some providers reported increase in their workload (social work, nutrition) while others’ workload was unaffected (gastroenterology, nursing). No physicians attended team meetings regularly. Regular in-person meetings helped to strengthen the team. Involving physicians as consultants on an ad hoc basis without regular meeting attendance empowered other team members to take ownership of the IBD Home.
Fox A, Reeves S. Interprofessional collaborative patient-centred care: A critical exploration of two related discourses. J Interprof Care. 2015;29(2):113–8. DOI: https://doi.org/10.3109/13561820.2014.954284
Clay MA, Sikon AL, Lypson ML, Gomez A, Kennedy-Malone L, Bussey-Jones J, et al. Teaching while learning while practicing: Reframing faculty development for the patient-centered medical home. Acad Med. 2013;88(9):1215–9. DOI: https://doi.org/10.1097/ACM.0b013e31829ecf89
Kirschner N, Greenlee C, American College of Physicians. The Patient-Centered Medical Home Neighbor: The Interface of the patient centered medical home with specialty/subspecialty practices. American College of Physicians. Philadelphia, PA; 2010.
Gimm G, Goldberg DG, Ghanem N, Haghighat S, Want J, Hough D, et al. Provider Experiences with a Payer-Based PCMH Program. J Gen Intern Med. 2019; DOI: https://doi.org/10.1007/s11606-019-05005-7
Peter F. Cronholm, MD, MSCE; Heather Klusaritz, PhD, MSW; Giang T. Nguyen, MD, MSCE, MPH; Katherine Kellom; Matthew Kearney, MPH; Michelle Miller-Day, PhD; Robert Gabbay, MD P. Resident Engagement in the Patient-Centered Medical Home. Fam Med [Internet]. 2016 [cited 2019 Jun 20];48(8):603–12. Available from: https://www.stfm.org/FamilyMedicine/Vol48Issue8/Cronholm603
Sklar M, Seijo C, Goldman RE, Eaton CB. Beyond checkboxes: A qualitative assessment of physicians’ experiences providing care in a patient-centred medical home. J Eval Clin Pract. 2019;(December 2018):1–10.
Loeb DF, Bayliss EA, Candrian C, DeGruy F V., Binswanger IA. Primary care providers’ experiences caring for complex patients in primary care: A qualitative study. BMC Fam Pract [Internet]. 2016;17(1):1–9. Available from: http://dx.doi.org/10.1186/s12875-016-0433-z DOI: https://doi.org/10.1186/s12875-016-0433-z
Huang X, Rosenthal MB. Transforming Specialty Practice — The Patient-Centered Medical Neighborhood. N Engl J Med. 2014 Apr;370(15):1376–9. DOI: https://doi.org/10.1056/NEJMp1315416
Itri JN. Patient-centered Radiology. RadioGraphics. 2015;35(6):1835–46. DOI: https://doi.org/10.1148/rg.2015150110
Regueiro MD, McAnallen SE, Greer JB, Perkins SE, Ramalingam S, Szigethy E. The Inflammatory Bowel Disease Specialty Medical Home: A New Model of Patient-centered Care. Inflamm Bowel Dis. 2016;22(8):1971–80. DOI: https://doi.org/10.1097/MIB.0000000000000819
Sakshaug JW, Miller DC, Hollenbeck BK, Wei JT, Hollingsworth JM. Urologists and the patient centered medical home. J Urol. 2013;190(4):1345–9. DOI: https://doi.org/10.1016/j.juro.2013.03.119
Friedberg MW, Rosenthal MB, Werner RM, Volpp KG, Schneider EC. Effects of a Medical Home and Shared Savings Intervention on Quality and Utilization of Care. JAMA Intern Med [Internet]. 2015 Aug 1 [cited 2019 Jan 30];175(8):1362. Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2015.2047 DOI: https://doi.org/10.1001/jamainternmed.2015.2047
Kirschner N, Barr MS. Specialists/subspecialists and the patient-centered medical home. Chest [Internet]. 2010 Jan [cited 2019 May 1];137(1):200–4. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0012369210600347 DOI: https://doi.org/10.1378/chest.09-0060
Kruimel J, Leue C, Winkens B, Marcus D, Schoon S, Dellink R, et al. Integrated medical–psychiatric outpatient care in functional gastrointestinal disorders improves outcome. Eur J Gastroenterol Hepatol [Internet]. 2015 Jun [cited 2019 May 1];27(6):721–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25831133 DOI: https://doi.org/10.1097/MEG.0000000000000335
Friedberg MW, Schneider EC, Rosenthal MB, Volpp KG, Werner RM. Association Between Participation in a Multipayer Medical Home Intervention and Changes in Quality, Utilization, and Costs of Care. JAMA [Internet]. 2014 Feb 26 [cited 2019 May 1];311(8):815. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2014.353 DOI: https://doi.org/10.1001/jama.2014.353
Koltun WA. Better together: improved care of the IBD patient using the multi-disciplinary IBD center. Expert Rev Gastroenterol Hepatol [Internet]. 2017 Jun 3 [cited 2019 May 1];11(6):491–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28317406 DOI: https://doi.org/10.1080/17474124.2017.1309289
Szigethy EM, Allen JI, Reiss M, Cohen W, Perera LP, Brillstein L, et al. White Paper AGA: The Impact of Mental and Psychosocial Factors on the Care of Patients With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol [Internet]. 2017 Jul [cited 2019 Jan 17];15(7):986–97. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1542356517302793 DOI: https://doi.org/10.1016/j.cgh.2017.02.037
Mikocka-Walus AA, Andrews JM, Bernstein CN, Graff LA, Walker JR, Spinelli A, et al. Integrated models of care in managing inflammatory bowel disease: a discussion. Inflamm Bowel Dis [Internet]. 2012 Aug [cited 2019 Jan 30];18(8):1582–7. Available from: https://academic.oup.com/ibdjournal/article/18/8/1582-1587/4607736 DOI: https://doi.org/10.1002/ibd.22877
Click B, Regueiro M. The Inflammatory Bowel Disease Medical Home: From Patients to Populations. Inflamm Bowel Dis. 2019;XX(Xx):1–5. DOI: https://doi.org/10.1093/ibd/izz062
Regueiro M, Click B, Anderson A, Shrank W, Kogan J, McAnallen S, et al. Reduced Unplanned Care and Disease Activity and Increased Quality of Life After Patient Enrollment in an Inflammatory Bowel Disease Medical Home. Clin Gastroenterol Hepatol [Internet]. 2018;16(11):1777–85. Available from: https://doi.org/10.1016/j.cgh.2018.04.007 DOI: https://doi.org/10.1016/j.cgh.2018.04.007
Long T, Dann S, Wolff ML, Brienza RS. Moving from silos to teamwork: Integration of interprofessional trainees into a medical home model. J Interprof Care. 2014;28(5):473–4. DOI: https://doi.org/10.3109/13561820.2014.891575
Leasure EL, Jones RR, Meade LB, Sanger MI, Thomas KG, Tilden VP, et al. There is no “i” in teamwork in the patient- Centered medical home: Defining teamwork competencies for academic practice. Acad Med. 2013;88(5):585–92. DOI: https://doi.org/10.1097/ACM.0b013e31828b0289
Hager K, St Hill C, Prunuske J, Swanoski M, Anderson G, Lutfiyya MN. Development of an interprofessional and interdisciplinary collaborative research practice for clinical faculty. J Interprof Care. 2016;30(2):265–7. DOI: https://doi.org/10.3109/13561820.2015.1092951
QSR International Pty Ltd. NVivo qualitative data analysis Software. 2014.
Blumenthal D, McCarthy D, Shah TB. Academic Medical Centers and High-Need, High-Cost Patients: A Call to Action. Acad Med. 2018 Nov;93(11):1617–9. DOI: https://doi.org/10.1097/ACM.0000000000002334
McCarthy D, Ryan J, Klein S. Models of Care for High-Need, High-Cost Patients: An Evidence Synthesis. Issue Brief (Commonw Fund). 2015 Oct;31:1–19.
Kosinski LR, Brill J, Regueiro M. Making a Medical Home for IBD Patients. Curr Gastroenterol Rep. 2017 DOI: https://doi.org/10.1007/s11894-017-0561-1
- Abstract views: 585
- PDF: 68
Copyright (c) 2020 The Authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.