Effect of Integrated Gastroenterology Specialists in a Primary Care Setting: a Retrospective Cohort Study

Background: Gastrointestinal (GI) complaints are common in primary care practices. The patient-centered medical home (PCMH) may improve coordination and collaboration by facilitating coordination across healthcare settings and within the community, enhancing communication between providers, and focusing on quality of care delivery. Objective: To investigate the effect of integrated community gastroenterology specialists (ICS-GI) model within a large primary care practice. Design: Retrospective cohort with propensity-matched historic controls. Patients: We identified 265 patients who had a visit with one of our ICS-GI specialists and matched them (1:2) to 530 similar patients seen prior to the implementation of the ICS-GI model. Main Measures: Frequency of diagnostic testing for GI indications, visits to our outpatient GI referral practice, emergency department and hospital utilization, and time to access of specialty care for the whole population and by GI condition group. Key Results: Patients seen in our ICS-GI model had similar outpatient care utilization (OR = 1.0, 95% CI 0.7–1.4, p = 0.90), were more likely to have visits in primary care (OR OR=1.5, 95% CI 1.1–2.2, p = 0.02), and were less likely to have visits to our GI outpatient referral practice (OR = 0.3, 95% CI 0.2–0.7, p < 0.0001). Condition-specific analyses show that all GI conditions experienced decreased visits to the outpatient GI referral practice outside of patients with GI neoplasm. Populations did not differ in emergency department, hospital, or diagnostic utilization. Conclusions: We observed that an embedded specialist in primary care model is associated with improved care coordination without compromising patient safety. The PCMH could be extended to include subspecialty care.