P017 The CONCERT Initiative: Baseline Study Findings From a Gastroenterologist Perspective
Authors: Chapman Casey , Griffith Jenny , Bruno Michelle , Lynch Joe , McClain Jasmaine , Zambrano Javier , Fifer Sheila 
Published: December 2019

BACKGROUND:

Receiving timely or comprehensive care are well-documented challenges among inflammatory bowel disease (IBD) patients. The lack of timely/comprehensive care often leads to avoidable complications or hospitalization. IBD medical homes have addressed some challenges, but more approaches are needed for community-based settings to ensure appropriate identification of patients and timelier care. The IBD Care Referral Pathway, developed by the American Gastroenterological Association, aims to improve care coordination among providers who manage IBD patients through education of IBD symptoms and high-risk patient characteristics. The CONCERT study, launched in 2019, assesses implementation and acceptance of the Pathway by community-based clinicians in primary care, gastroenterology, and emergency department settings. This analysis summarizes findings from 26 participating gastroenterology clinicians (i.e., physicians, nurse practitioners, and physician assistants).

METHODS:

Prior to introducing the Pathway intervention, clinicians from a gastroenterology community practice completed a knowledge attainment survey (KAS) testing familiarity on key IBD characteristics, recommended clinical assessments, and management practices. The Pathway intervention included: written educational materials; an in-person tutorial; and a Pathway Checklist to document identification and risk-stratification of a patient’s condition, along with next steps regarding referrals or consultations. Clinicians were asked to complete the Pathway Checklist in each adult IBD patient encounter. Participating clinicians also completed a monthly acceptance survey to collect their ratings on value of the Pathway tools and convenience of using them in clinical practice.

RESULTS:

Responses to the KAS indicated that prior to intervention, participating gastroenterologists had only moderate familiarity with recommended IBD practices or making specialist referrals. The average score among 25 clinicians was 67% of correct answers. In the first monthly acceptance survey, 14 clinicians had seen an IBD patient in the applicable month. A large majority of them “never” or “seldom” made referrals to selected specialists: 43% never or seldom referred to another GI specialist; 79% to a dietitian; and 100% to a behavioral health provider. Additionally, from 135 checklists indicating a potential need for patient referral to specialized care, results align with the low reported referral rates among monthly survey respondents. Only 18 of those checklists (13%) marked a referral to be made: 16 to other GI clinicians, one to behavioral health, and one for nutrition services. Most common reasons for not referring were that gastrointestinal services suggested by the pathway were provided during the office visit, and there was poor access to the desired specialists. Nonetheless, a majority of responding clinicians reported high ratings for the usefulness of the Pathway Checklist: 79% rated it as either an “Excellent” or “Good” tool to select IBD patients for referrals.

CONCLUSION(S):

Findings suggest room for improvement among gastrointestinal clinicians to readily recognize IBD characteristics and direct patients to needed specialized care. High ratings of checklist’s usefulness indicate that such tools can gain acceptance among clinicians to aid implementation of a referral pathway. By helping to risk-stratify patients, this tool provides a clear reference for efficiently directing IBD care and has the potential to raise IBD care standards for the community.