Establishing a medical home for patients with inflammatory bowel diseases: a qualitative study

Abstract

The Patient-Centered Medical Home model has gained popularity in primary care to provide early effective care to patients with chronic conditions. Prior research on specialty medical homes has been cross-sectional and focused on patient outcomes. The objective of this longitudinal qualitative study was to identify best practices in establishing a specialty medical home in Inflammatory Bowel Diseases (IBD Home). The multimethod study included direct observations of multidisciplinary team meetings (30 hours over one year) and in-depth interviews with individual team members (N=11) and referring physicians (N=6) around their participation in the IBD home. All interviews were professionally transcribed verbatim. Two researchers coded transcripts for themes using NVivo software. Weekly team meetings (N=9±3) included behavioral health providers, nurse practitioners, nurses, dietitians, a clinical pharmacist, and clinical coordinators. Physicians referred patients with psychosocial comorbidities to the IBD home. Initially the team enrolled all referred patients. Later, they developed exclusion criteria and a patient complexity score to manage the volume. Some providers reported increase in their workload (social work, nutrition) while others’ workload was unaffected (gastroenterology, nursing). No physicians attended team meetings regularly. Regular in-person meetings helped to strengthen the team. Involving physicians as consultants on an ad hoc basis without regular meeting attendance empowered other team members to take ownership of the IBD Home.