Corey Siegel, MD, on Improving IBD Care Models

• Inflammatory bowel disease (IBD) is projected to affect ~1 in 100 people by 2035. Current care is limited by undertreatment, therapeutic indecision due to the expanding number of medications, and provider capacity strain.
• RADIUS (Rural APPs Delivering IBD Care in the US)—a hub-and-spoke model from Dartmouth-Hitchcock Medical Center—connects expert IBD centers with community APPs for one-time, 2-hour multidisciplinary consults, and has shown widespread acceptance by patients and provides.
• Early outcomes show higher advanced therapy utilization, improved patient and provider satisfaction, and expanded access via hubs in New England, Oregon, Colorado, and Tennessee.

In the J Edward Burke Distinguished Lecture at the ACG Scientific Meeting, Dr Corey Siegel outlined 5 problems in advancing the care of patients with inflammatory bowel disease, and discussed how the RADIUS program begun at his institution has expanded and offers one possible solution to the future challenges in IBD care.

Corey A. Siegel, MD, MS, is the Constantine and Joyce Hampers Professor of Medicine at the Geisel School of Medicine at Dartmouth and director of the Walter and Carol Young Center for Digestive Health at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.

Hi, I‘m Corey Siegel. I'm the director of the Walter and Carol Young Center for Digestive Health at the Dartmouth-Hitchcock Medical Center. I'm here at ACG and I was honored to deliver the J Edward Burke Distinguished lectureship about how we can improve IBD care models.

Looking into the future, I discussed some problems that are all coming together in IBD care that we need to address. There were 5 that I touched on. One was that by 2035, approximately 1 in 100 people are going to have inflammatory bowel disease. And this comes at a time where the current state of care is that our patients are being vastly undertreated with the really effective medications that we have. So we have to think about how to get patients treated sooner and to the right providers.

However, the field is evolving so quickly, and problem number 3 is although we have so many choices now for medications, it almost leads to this paralysis of decision that many people aren't getting on any advanced therapies over time.

Now, layer on top of that problem number 4, which is a clear determination that multidisciplinary care is really needed for these patients. It's not just a one-on-one sport with the gastroenterologist, but we need help from psychologists and dieticians and pharmacists and nurses to really think this through.

Now, the 5th problem is that there's so much pressure to do endoscopy now on all gastroenterologists, whether it be in community practice or academic centers, that they're getting pulled away from the clinic where we have this growing need of a rapidly moving field with undertreatment and a lack of resources.

So we have to think together how we really shake things up. Are we delivering IBD care now a way that's sustainable to help this patient population going to the future? There are probably a number of solutions for this. The one that I focused on in my lecture was a program that we call RADIUS, which stands for Rural APPs Delivering IBD Care in the United States. This is set up as a hub and spoke model. The hubs are big IBD centers. This doesn't need to be an academic medical center. It doesn't even need to be people who trained specifically in IBD. It needs to be a group of providers who are really passionate to dig in and kind of go all in on taking care of IBD patients.

The spokes are people in community practices, primarily APPs who would love the help of an expert team managing their patients. They refer their patients in and with a one-time, 2-hour visit, we give a comprehensive review for these patients directly with them and then send them back to the referring providers. What this allows is the patients to really hear from a multidisciplinary team. It allows the hub site specialist team to be able to consistently see new patients over time because they're referring their patients back for their continuity of care in the community. And it allows for these amazing APPs who are highly skilled and talented to hold onto their patients and continuing managing their patients, but always having a specialist team in their back pocket for help is needed.

In our experience, this has been wildly successful. Patients have loved it. The referring providers have loved working with the specialists, and also we've learned that the rate of utilization of advanced therapy has dramatically increased in this group. That's helping us see what we hope to be better outcomes for the future.

Now again, there are a lot of different ways that we can redesign healthcare for the future. For IBD, we think that RADIUS is one, and we really hope that people take us up on this idea and create their own models or work with us in RADIUS to help see more patients. We currently now have hubs in the northern New England area with me at Dartmouth; in Portland, Oregon with Dr. Donald Lum; Dr. Ben Click at the University of Colorado in Denver; and Dr. Sara Horst in Vanderbilt with this base. We hope to build this out over time and also inspire other ideas for you to help us make care better for the future for our patients. So thank you.