Heartburn Center Set-Up in a Community Setting: Engineering and Execution
Background: Optimal management of gastroesophageal reflux disease (GERD) requires a concerted team of physicians rather than an individual approach. While an integrated approach to GERD has previously been proposed, the practical execution of such a “center of excellence” (COE) has not been describe...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:44948826a70c4b77b90f51dcc5e3703a2021-11-10T05:52:04ZHeartburn Center Set-Up in a Community Setting: Engineering and Execution2296-858X10.3389/fmed.2021.662007https://doaj.org/article/44948826a70c4b77b90f51dcc5e3703a2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.662007/fullhttps://doaj.org/toc/2296-858XBackground: Optimal management of gastroesophageal reflux disease (GERD) requires a concerted team of physicians rather than an individual approach. While an integrated approach to GERD has previously been proposed, the practical execution of such a “center of excellence” (COE) has not been described, particularly in a community setting. Ranging from initial consultation and diagnosis to surgical intervention for complex disease, such an approach is likely to provide optimal care and provide surveillance for patients with a complex disease process of GERD.Methods: We report our approach to implement an integrated heartburn center (HBC) and our experience with the first cohort of patients. Patients treated in the HBC were followed for 2 years from initial consultation to completion of their appropriate treatment plan, including anti-reflux surgery. The performance prior to the HBC set-up was compared to that post-HBC. Performance was measured in terms of volume of patients referred, referral patterns, length of stay (LOS), and patient health-related quality of life (HRQL) pre- and post-surgery.Results: Setting up the HBC resulted in referrals from multiple avenues, including primary care physicians (PCPs), emergency departments (EDs), and gastroenterologists (GIs). There was a 75% increase in referrals compared to pre-center patient volumes. Among the initial cohort of 832 patients presenting to the HBC, <10% had GERD for <1 year, ~60% had GERD for 1–11 years, and ~30% had GERD for ≥12 years. More than one-quarter had atypical GERD symptoms (27.6%). Only 6.4% had been on PPIs for <1 year and >20% had been on PPIs for ≥12 years. Thirty-eight patients were found to have Barrett's esophagus (4.6%) (up to 10 times the general population prevalence). Two patients had dysplasia. Seven patients (0.8%) received radiofrequency ablation (RFA) for Barrett's esophagus and two patients received endoscopic mucosal resection (EMR) for Barrett's esophagus-related dysplasia. The most common comorbidities were chronic pulmonary disease (16.8%) and diabetes without complications (10.6%). Patients received treatment for newly identified comorbid conditions, including early maladaptive schemas (EMS) and generalized anxiety disorder (GAD) (n = 7; 0.8%). Fifty cases required consultation with various specialists (6.0%) and 34 of those (4.1%) resulted in changes in care. Despite the significant increase in patient referrals, conversion rates from diagnosis to anti-reflux surgery remained consistent at ~25%. Overall HRQL improved year-over-year, and LOS was significantly reduced with potential cost savings for the larger institution.Conclusions: While centralization of GERD care is known to improve outcomes, in this case study we demonstrated the clinical success and commercial viability of centralizing GERD care in a community setting. The integrated GERD service line center offered a comprehensive, multi-specialty, and coordinated patient-centered approach. The approach is reproducible and may allow hospitals to set up their own heartburn COEs, strengthening patient-community relationships and establishing scientific and clinical GERD leadership.Atul MainiJohn SunBorys BuniakStacey JantschRachel CzajakTara FreyB. Siva KumarAmarpreet ChawlaFrontiers Media S.A.articlegastroesophageal reflux disease (GERD)center of excellence (CoE)heartburn center (HBC)quality of life (HRQL)length of stay (LOS)Medicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
gastroesophageal reflux disease (GERD) center of excellence (CoE) heartburn center (HBC) quality of life (HRQL) length of stay (LOS) Medicine (General) R5-920 |
| spellingShingle |
gastroesophageal reflux disease (GERD) center of excellence (CoE) heartburn center (HBC) quality of life (HRQL) length of stay (LOS) Medicine (General) R5-920 Atul Maini John Sun Borys Buniak Stacey Jantsch Rachel Czajak Tara Frey B. Siva Kumar Amarpreet Chawla Heartburn Center Set-Up in a Community Setting: Engineering and Execution |
| description |
Background: Optimal management of gastroesophageal reflux disease (GERD) requires a concerted team of physicians rather than an individual approach. While an integrated approach to GERD has previously been proposed, the practical execution of such a “center of excellence” (COE) has not been described, particularly in a community setting. Ranging from initial consultation and diagnosis to surgical intervention for complex disease, such an approach is likely to provide optimal care and provide surveillance for patients with a complex disease process of GERD.Methods: We report our approach to implement an integrated heartburn center (HBC) and our experience with the first cohort of patients. Patients treated in the HBC were followed for 2 years from initial consultation to completion of their appropriate treatment plan, including anti-reflux surgery. The performance prior to the HBC set-up was compared to that post-HBC. Performance was measured in terms of volume of patients referred, referral patterns, length of stay (LOS), and patient health-related quality of life (HRQL) pre- and post-surgery.Results: Setting up the HBC resulted in referrals from multiple avenues, including primary care physicians (PCPs), emergency departments (EDs), and gastroenterologists (GIs). There was a 75% increase in referrals compared to pre-center patient volumes. Among the initial cohort of 832 patients presenting to the HBC, <10% had GERD for <1 year, ~60% had GERD for 1–11 years, and ~30% had GERD for ≥12 years. More than one-quarter had atypical GERD symptoms (27.6%). Only 6.4% had been on PPIs for <1 year and >20% had been on PPIs for ≥12 years. Thirty-eight patients were found to have Barrett's esophagus (4.6%) (up to 10 times the general population prevalence). Two patients had dysplasia. Seven patients (0.8%) received radiofrequency ablation (RFA) for Barrett's esophagus and two patients received endoscopic mucosal resection (EMR) for Barrett's esophagus-related dysplasia. The most common comorbidities were chronic pulmonary disease (16.8%) and diabetes without complications (10.6%). Patients received treatment for newly identified comorbid conditions, including early maladaptive schemas (EMS) and generalized anxiety disorder (GAD) (n = 7; 0.8%). Fifty cases required consultation with various specialists (6.0%) and 34 of those (4.1%) resulted in changes in care. Despite the significant increase in patient referrals, conversion rates from diagnosis to anti-reflux surgery remained consistent at ~25%. Overall HRQL improved year-over-year, and LOS was significantly reduced with potential cost savings for the larger institution.Conclusions: While centralization of GERD care is known to improve outcomes, in this case study we demonstrated the clinical success and commercial viability of centralizing GERD care in a community setting. The integrated GERD service line center offered a comprehensive, multi-specialty, and coordinated patient-centered approach. The approach is reproducible and may allow hospitals to set up their own heartburn COEs, strengthening patient-community relationships and establishing scientific and clinical GERD leadership. |
| format |
article |
| author |
Atul Maini John Sun Borys Buniak Stacey Jantsch Rachel Czajak Tara Frey B. Siva Kumar Amarpreet Chawla |
| author_facet |
Atul Maini John Sun Borys Buniak Stacey Jantsch Rachel Czajak Tara Frey B. Siva Kumar Amarpreet Chawla |
| author_sort |
Atul Maini |
| title |
Heartburn Center Set-Up in a Community Setting: Engineering and Execution |
| title_short |
Heartburn Center Set-Up in a Community Setting: Engineering and Execution |
| title_full |
Heartburn Center Set-Up in a Community Setting: Engineering and Execution |
| title_fullStr |
Heartburn Center Set-Up in a Community Setting: Engineering and Execution |
| title_full_unstemmed |
Heartburn Center Set-Up in a Community Setting: Engineering and Execution |
| title_sort |
heartburn center set-up in a community setting: engineering and execution |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/44948826a70c4b77b90f51dcc5e3703a |
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