Creation of an Inflammatory Bowel Disease Referral Pathway for Identifying Patients Who Would Benefit From Inflammatory Bowel Disease Specialist Consultation

Inflamm Bowel Dis. 2023 Aug 1;29(8):1177-1190. doi: 10.1093/ibd/izac216.


Frank I Scott 1Orna Ehrlich 2Dallas Wood 3Catherine Viator 3Carrie Rains 3Lisa DiMartino 3Jill McArdle 3Gabrielle Adams 4Lara Barkoff 5Jennifer Caudle 6Jianfeng Cheng 7Jami Kinnucan 8Kimberly Persley 9Jennifer Sariego 10Samir Shah 11Caren Heller 2David T Rubin 12



Author information

1Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

2Crohn's & Colitis Foundation, New York, NY, USA.

3RTI International, Research Triangle Park, NC, USA.

4Southwest Gastroenterology, Albuquerque, NM, USA.

5Albuquerque, NM, USA.

6Department of Family Medicine, Rowan University School of Osteopathic Medicine, Sewell, NJ, USA.

7Everett Clinic, Everett, WA, USA.

8Section of Gastroenterology and Hepatology Mayo Clinic, Jacksonville, FL, USA.

9GI Alliance Gastroenterologist Presbyterian, Dallas, TX, USA.

10Penn Medicine At Home, University of Pennsylvania Health System, Bala Cynwd, PA, USA.

11Division of Gastroenterology, Brown University, Providence, RI, USA.

12Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA.


Background: Recommendations regarding signs and symptoms that should prompt referral of patients with inflammatory bowel disease (IBD) to an IBD specialist for a consultation could serve to improve the quality of care for these patients. Our aim was to develop a consult care pathway consisting of clinical features related to IBD that should prompt appropriate consultation.

Methods: A scoping literature review was performed to identify clinical features that should prompt consultation with an IBD specialist. A panel of 11 experts was convened over 4 meetings to develop a consult care pathway using the RAND/UCLA Appropriateness Method. Items identified via scoping review were ranked and were divided into major and minor criteria. Additionally, a literature and panel review was conducted assessing potential barriers and facilitators to implementing the consult care pathway.

Results: Of 43 features assessed, 13 were included in the care pathway as major criteria and 15 were included as minor criteria. Experts agreed that stratification into major criteria and minor criteria was appropriate and that 1 major or 2 or more minor criteria should be required to consider consultation. The greatest barrier to implementation was considered to be organizational resource allocation, while endorsements by national gastroenterology and general medicine societies were considered to be the strongest facilitator.

Conclusions: This novel referral care pathway identifies key criteria that could be used to triage patients with IBD who would benefit from IBD specialist consultation. Future research will be required to validate these findings and assess the impact of implementing this pathway in routine IBD-related care.

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