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

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

Abstract

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.