Effect of digestive health care services integration on resource use and outcomes in patients with digestive disorders☆☆☆★★★

Abstract 

Background & Aims: Academic medical centers are under pressure to contain resources. The University of Virginia Digestive Health Service Center (DHSC) is a fully integrated inpatient service combining gastroenterology, hepatology, surgery, pathology, radiology, and nutritional services. The aim of this study was to evaluate whether integration of digestive health services can contain resource use among gastrointestinal (GI) inpatient admissions. Methods: This is a cohort study of 2934 inpatient cases admitted to a referral academic medical center between January 1, 1998, and June 30, 2000, with a primary diagnosis of an esophageal disorder, appendicitis, abdominal hernia, intestinal obstruction, diverticulitis, biliary tract disease, liver disease, a pancreatic disorder, or GI hemorrhage. Cases were grouped by admitting service (DHSC vs. other nonintegrated inpatient services). Total cost, length of stay, and 30-day readmission rate were adjusted for differences in baseline patient characteristics and compared. Results: DHSC admission was associated with significant cost savings (P = 0.0363) and reduced length of stay (P < 0.0001). Cost savings were attributable to patients admitted for liver disease (P = 0.0077), GI hemorrhage (P = 0.0031), and diverticulitis (P = 0.0497); reductions in length of stay were seen for patients with liver disease (P = 0.0314), GI hemorrhage (P = 0.0212), diverticulitis (P = 0.0017), esophageal disorders (P = 0.0006), and abdominal hernia (P = 0.0458). DHSC patients with pancreatic disorders had increased total cost (P = 0.0247), but no difference in length of stay (P = 0.7504) and a lower 30-day readmission rate (P = 0.0478). Conclusions: Integration of digestive health services reduces resource use for patients with digestive diseases and may improve outcomes for patients with pancreatic disorders. A multidisciplinary service center may represent a more efficient model for health care delivery for these patients.

Abbreviations:  CI , confidence interval, DHSC , Digestive Health Service Center, GI , gastrointestinal, ICD , International Classification of Diseases