HJNO Jan/Feb 2025

CHANGING THE CARE: IBD 30 JAN / FEB 2025 I  HEALTHCARE JOURNAL OF NEW ORLEANS   scribed in their book, Redefining Healthcare: Creating Value-Based Competition on Results. In a subsequent article written by Porter and Thomas Lee, MD, MSc, they describe how “The playbook for assembling and integrating a successful Integrated Practice Unit (IPU) fea- tures several key steps, including defining the patient condition or set of related conditions to be served, as well as defining patient needs across the care cycle and mapping the process- es involved to meet those needs. Leaders then need to assemble a multidisciplinary team by identifying the appropriate mix of clinical and patient support personnel to address the full care cycle, including common comorbid medi- cal conditions and complications. Execution involves the creation of a number of mecha- nisms that facilitate and support integration across the team, including physical, financial, and IT elements.” 1 Shah and her IBD special- ist colleague, Gregory Gaspard, MD, only see patients with IBD, thereby developing a set of specialized expertise on this condition that is among the foremost developed in the world. Whereas a typical IBD specialist may only care for 300 to 400 IBD patients, she and Gaspard are now able to care for over 1300 IBD patients. They have invested a considerable amount of time and expertise into developing standard- ized care protocols on how to manage IBD complications and related conditions. Since clinically unwarranted practice pattern varia- tion, even among specialists, is one of the big- gest problems that compromises outcomes in healthcare, corralling clinically unwarranted variability requires considerable effort, but it is well worth the time and effort. Within those standardized care protocols are treatment con- siderations and management approaches for various conditions. These protocols include standardized approach to fevers, diarrhea, liv- er abnormalities, and others but also provide guidance to fellows and general gastroenter- ologists on inpatient approach to IBD patients. They have also worked with various colleagues in other departments on these protocols, for example, more recently also collaborating with oncology colleagues on diagnostic and treat- ment approach to diarrhea in patients who are receiving immunotherapy. Seasoned clini- cians understand that even though doctors all go to medical school, that amount and types of training each doctor receives can be quite different across providers. Even more different is the amount of up-to-date knowledge that each physician has stored in their brains. Fur- thermore, no matter how up to date a given clinician might strive to be, new knowledge gets added to the medical literature faster than ever before. It takes well designed systems and processes to capture that knowledge and ensure that it is continuously updated and reli- ably applied. So, even a complaint as common to IBD patients as fever will be painstakingly evaluated in a matter that is scalable and re- liably reproducible. Since the biologic agents used in the treatment of IBD routinely suppress a person’s immune system, thus rendering them more susceptible to conditions such as hepatitis B or tuberculosis, it takes these highly standardized protocols to ensure that the pre- vention and management approach to these conditions is replicated from patient to pa- tient every single time. Similar protocols have been created to standardize the approach to evaluation of abnormal liver enzymes, diarrhea, and multiple other presenting complaints. Shamita B. Shah, MD Over the past decade, IBD has become more complex with many new emerging medical therapies. These rapid changes create more challenges for the general gastroenterologist to stay current and to enable the state-of-the- art approach to IBD care. After my training and my experience in building an IBD program at Stanford University, I was excited about bring- ing this knowledge back to New Orleans to work within an organization that saw merit in developing a team-based, IBD-focused ap- proach within a larger gastroenterology de- partment. My passion has been driven by a personal connection within the field as my fa- ther died of complications of ulcerative colitis. I am certain that he would have had a better outcome if cared for by an expert provider. My professional goal has been to positively impact as many patients with IBD as possible. Over the last nine years, I have focused on developing a medical care team and specialty clinic that focuses only on IBD care. I am fortu- nate that the organization has recognized the value of supporting this model, which does not have the same typical direct renumeration asso- ciated with general GI care, with the associated high endoscopy procedural volumes. Our IBD care team includes: 1) gastroenterologists who focus their practice on patients with IBD only — myself and Gregory Gaspard, MD; 2) a nurse clinical care coordinator responsible for coor- dinating new patient access, including triaging new patient referrals and collecting our check- list of needed clinical information for physician review prior to any scheduled visit; 3) dedicated IBD nurse navigators to coordinate diagnostic testing and treatment plans, and help man- age patient phone calls and messages; and 4) clinic-based pharmacists that provide compre- hensive medication management to optimize medication adherence and overall outcomes. With the goal of reaching as many patients as possible, our team has initiated various mea- sures over the last five years. Some of these have included: 1) maintaining active physician state licenses in Gulf Coast states to allow for continued telehealth visits for regional, out- of-state patients who were referred to us for specialty care; 2) supporting e-consults from within our organization for other general gas- troenterologists to help them optimize care for their patients without need for transfer- ring care to our team; 3) creating and sustain- ing an inpatient service to care for hospital- ized patients with acute Crohn’s and colitis, 4) creating a pediatric to adult IBD transition program to facilitate seamless transition of care; and 5) initiating a monthly clinical care conference at which other Ochsner gastroen- terologists can discuss complex cases with the IBD team directly. Utilizing clinical care pro- tocols that have standardized our approach to IBD care has immensely helped us to de- liver optimal care at all levels of our care team. Although my hope is that optimizing medi- cal therapy will maintain good health for all our patients with IBD, close collaboration with colorectal surgery is necessary for any complete IBD center. We are fortunate to have colorectal surgery experts cohabitate with our clinic. Pa- tients in need of colorectal surgery input can be seen the same day. Some patients with IBD will develop extraintestinal manifestations and may need input for other specialties. Our teamworks closely with specialists in dermatology, rheuma- tology, hepatology, ophthalmology, and infec- tious disease to address these types of issues.