Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2015; 21(7): 2152-2158
Published online Feb 21, 2015. doi: 10.3748/wjg.v21.i7.2152
Establishing an integrated gastroenterology service between a medical center and the community
Yaron Niv, Ram Dickman, Zohar Levi, Gadi Neumann, Dorit Ehrlich, Haim Bitterman, Jacob Dreiher, Arnon Cohen, Doron Comaneshter, Eyran Halpern
Yaron Niv, Ram Dickman, Zohar Levi, Gadi Neumann, Eyran Halpern, Rabin Medical Center, Clalit Health Services, Tel Aviv University, Petach Tikva 49100, Israel
Dorit Ehrlich, Dan - Petach Tikva District, Clalit Health Services, Petach Tikva 49100, Israel
Haim Bitterman, Jacob Dreiher, Arnon Cohen, Doron Comaneshter, General Management, Clalit Health Services, Tel Aviv-Yafo 6997801, Israel
Author contributions: Niv Y designed research, collected and analyzed data, analyzed and wrote the manuscript; Dickman R performed research and helped in writing the paper; Levi Z contributed new clinical approaches; Neumann G, Ehrlich D, Bitterman H and Halpern E designed research; Dreiher J designed research and quality indicators; Cohen A designed quality indicators; Comaneshter D designed quality indicators and performed statistics.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Yaron Niv, MD, AGAF, FACG, Professor, Rabin Medical Center, Clalit Health Services, Tel Aviv University, P.O. Box 39040, Petach Tikva 49100, Israel. yniv@clalit.org.il
Telephone: +972-3-9377237 Fax: +972-3-9210313
Received: May 31, 2014
Peer-review started: June 3, 2014
First decision: July 9, 2014
Revised: July 18, 2014
Accepted: September 5, 2014
Article in press: September 5, 2014
Published online: February 21, 2015
Abstract

AIM: To combine community and hospital services in order to enable improvements in patient management, an integrated gastroenterology service (IGS) was established.

METHODS: Referral patterns to specialist clinics were optimized; open access route for endoscopic procedures (including esophago-gastro-duodenoscopy, sigmoidoscopy and colonoscopy) was established; family physicians’ knowledge and confidence were enhanced; direct communication lines between experts and primary care physicians were opened. Continuing education, guidelines and agreed instructions for referral were promoted by the IGS. Six quality indicators were developed by the Delphi method, rigorously designed and regularly monitored. Improvement was assessed by comparing 2010, 2011 and 2012 indicators.

RESULTS: An integrated delivery system in a specific medical field may provide a solution to a fragmented healthcare system impaired by a lack of coordination. In this paper we describe a new integrated gastroenterology service established in April 2010. Waiting time for procedures decreased: 3 mo in April 30th 2010 to 3 wk in April 30th 2011 and stayed between 1-3 wk till December 30th 2012. Average cost for patient’s visit decreased from 691 to 638 NIS (a decrease of 7.6%). Six health indicators were improved significantly comparing 2010 to 2012, 2.5% to 67.5%: Bone densitometry for patients with inflammatory bowel disease, preventive medications for high risk patients on aspirin/NSAIDs, colonoscopy following positive fecal occult blood test, gastroscopy in Barrett’s esophagus, documentation of family history of colorectal cancer, and colonoscopy in patients with a family history of colorectal cancer.

CONCLUSION: Establishment of an IGS was found to effectively improve quality of care, while being cost-effective.

Keywords: Gastroenterology, Direct referral, Endoscopy, Community medicine, Open access endoscopy

Core tip: We combined community and hospital services in order to improve patient management, and established an integrated gastroenterology service (IGS). Referral patterns to specialist clinics were optimized; open access route for endoscopic procedures was established; family physicians' knowledge was enhanced; direct communication lines between experts and primary care physicians were opened. Six quality indicators were developed and regularly monitored. Waiting time for procedures decreased significantly, the average cost for patient's visit decreased 7.6%. Six health indicators were improved significantly comparing, 2.5% to 67.5% of the goals. Establishment of an IGS was found to effectively improve quality of care, while being cost-effective.