Management of nonurgent common gastroenterology referrals using primary care clinical pathways: Clinical outcomes, health care use, and avoided costs.

Abstract

Objective: To evaluate health system use, health outcomes, and avoided costs when patients with chronic gastrointestinal (GI) conditions are managed in the medical home.

Design: A retrospective, observational cohort study was conducted through a single-point-of-entry referral system.

Setting: Calgary, Alta.

Participants: Patients with referrals for any of 7 nonurgent indications.

Main outcome measures: Patients with referrals for any of 7 nonurgent indications were returned to primary care for management, guided by evidence-based primary care pathways. Patients were linked to administrative databases to extract indications, re-referral rates, endoscopy findings and outcomes, number of emergency department and urgent care visits, and number of hospital admissions. Costs avoided were estimated using Canadian Institute for Health Information data for health care use, consultation, and endoscopy.

Results: Between July 1, 2018, and May 31, 2020, a total of 3435 routine referrals were closed for 3274 patients. The most common pathway used was dyspepsia (1154 of 3435, 33.6%). A total of 362 patients (11.1%) had 616 GI-related emergency department or urgent care visits; 52 (1.6%) patients experienced 68 GI-related hospitalizations. A total of 396 patients (12.1%) underwent endoscopy; of the 348 patients with findings available for analysis, 7.8% exhibited a clinically significant finding. The estimated total cost avoided was $1,477,237.

Conclusion: The implementation of co-developed primary care pathways safely supports the care of patients with common, nonurgent GI conditions within the medical home. In this population, rates of re-referral and health care use were low, resulting in avoidance of substantial costs and improved overall appropriateness of care.