Abstract Background The demand for gastroenterology (GI) care in Canada outstrips the supply. In the Calgary Zone, a Central Access and Triage (CAT) model is used as a single point of entry for most GI referrals. In collaboration with primary care, clinical care pathways (CCP) were co-developed and implemented in CAT to support care for common GI referrals in the Primary Care Medical Home (PCMH), avoiding specialty consultation/endoscopy. Aims To evaluate the re-referral rate, health outcomes, health system utilization (emergency department (ED) visits and hospitalizations) and costs avoided for referrals managed in the PCMH. Methods A prospective observational cohort study of patient referrals declined (closed) by CAT for one of seven indications supported with CCPs: chronic abdominal pain, chronic constipation, chronic diarrhea, dyspepsia, reflux disease, Helicobacter pylori, and irritable bowel syndrome (IBS). Patient clinical records were linked to healthcare administrative databases to extract data: CAT, electronic medical records, discharge databases, and physician billing claims. The Pampalon Deprivation Index evaluated socioeconomic status and education level. Costs according to Canadian Institute for Health Information were estimated for healthcare utilization, consultation and endoscopy. Results A total of 3435 referrals were closed for 3274 patients during the study period (July 1, 2018 to May 31, 2020) with dyspepsia being the most common indication (34%). The median age was 45 years, 66% were women and 43% of higher socioeconomic status. Re-referral to GI occurred in 12% leading to 414 endoscopies performed in 348 patients, the majority were normal (93.6%). Two diagnoses of colorectal adenocarcinoma were identified: 1 originally referred for dyspepsia with subsequent colonoscopy for FIT positivity and 1 initially referred for chronic diarrhea but later presented with hematochezia. Over one year, 11% of patients visited an ED yet less than half for the same indication (42.7%, 263/616 visits) with abdominal pain, dyspepsia, and IBS as most common reasons. There were 52 patients with 68 hospitalizations, but only 24% related to GI referral (constipation and abdominal pain). Estimated total costs avoided was $(CA)2,275,344; and with estimated healthcare utilization of $1,440,281, the net costs avoided was $1,477,237. Conclusions Innovative, collaborative strategies aimed to better match supple-demand disparity and improve appropriateness of specialty GI referrals are critical to improving timely patient care. Use of CCPs to support care in the PCMH is safe and reduces costs. Continued development of such supports is important to reduce avoidable healthcare utilization. Funding Agencies Health Innovation Implementation and Spread (HIIS) Fund