Meeting the Challenges of Complex IBD Care Through a Multidisciplinary, Patient-Centric Approach

Inflammatory bowel disease (IBD) can be a debilitating and costly disease for many individuals that it afflicts. A patient’s underlying IBD diagnosis can be confounded with and impacted by any number of existing comorbidities and biopsychosocial influences. For some, having IBD and managing its chronic nature can be done with relative ease. For others, the disease can be an epic battle in which quality of life is profoundly altered and diminished. Complex cases and individuals presenting with difficult-to-control cases require an approach that places their condition at the center of their treatment while taking into account the full spectrum of health and well-being that may influence or contribute to poorly managed or controlled disease.

“As a program we take great pride in our patient-centered, targeted, team approach to IBD care that brings together medical, surgical, behavioral health, diet, and social work disciplines to achieve optimal results for a diverse and often complex patient population,” says Marc B. Schwartz, MD, clinical medical director of the UPMC Inflammatory Bowel Disease Center. 

“We strive to provide the best evidence-based care, tailored to the individual, in the most efficient manner by avoiding unnecessary tests and procedures while using the most appropriate care.  If we can arrive at a diagnosis more efficiently, and recognize and address patient comorbidities and life conditions that may affect the manifestation of their underlying IBD, we can provide better patient care. That’s our mission. Better patient care.”

The UPMC IBD Center is one of the largest in the country, and its integrated approach to patient care effectively spans the medical, surgical, behavioral, and rehabilitative worlds to address the ongoing needs of an often challenging and diverse patient population. The Center is one of only a handful in North America to be selected for participation in the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) IBD Genetics Consortium. At the University of Pittsburgh School of Medicine, the Division of Gastroenterology, Hepatology and Nutrition has in residence some of the foremost IBD researchers in the country, and they continue to make new contributions to the mechanistic understandings of IBD and optimizing long-term patient care.

Appreciating the Impact of Behavioral Health Comorbidities and Their Complex Interplay With IBD

A crucial aspect of IBD care at UPMC has involved, for many years, a concentration on the patient’s behavioral health status. As a psychiatrist, Eva Szigethy, MD, PhD, has been at the forefront of understanding the behavioral health modifiers and complexities often manifesting in IBD patients, either as distinct conditions or as a result of dealing with the long-term challenges of managing a chronic condition such as IBD.

“Dr. Szigethy and the behavioral health team she leads are fundamental components of our division’s IBD patient care and research,” says Dr. Schwartz. “The two cannot be separated. Her team’s clinical work and success in addressing the behavioral aspects of patient-focused IBD care have been borne out through numerous publications and research projects. Our program places significant emphasis on this aspect of care because we know it’s crucial to patients successfully managing their IBD. It comes down to finding root causes and understanding how those causes intermingle and affect one another in the individual patient.” 

Redefining IBD Care Through a Patient-Centered Medical Home Model

In 2015, the division launched a first-of-its-kind program to more effectively manage a subset of complex and challenging IBD patients who are insured through UPMC Health Plan. Dubbed UPMC Total Care-IBD, the program was the first patient-centered medical home for inflammatory bowel disease patients in the United States. Along with Drs. Schwartz and Szigethy, Elyse R. Johnston, MD, and Jeffrey M. Dueker, MD, MPH, form the team of providers currently seeing patients in the program.

The program was a new paradigm in how to care for this chronic and often complex disease state, a program designed for whole-person care through a multidisciplinary team approach. The UPMC Total Care-IBD medical home addresses symptom and disease management of the underlying condition, while taking into account the entirety of the individual’s health and well-being, rigorously addressing a patient’s concurrent behavioral health, socioeconomic, diet, and environmental factors that may contribute to acute changes in condition, long-term symptom presentation, and successful outcomes. UPMC Total Care-IBD addresses the patient experience, improves quality of care and quality of life, while reducing utilization of health care resources and costs through targeted, patient-centered interventions.

“Since our division launched UPMC Total Care-IBD, its fundamental model has been applied and developed into similar programs at other institutions, which we feel speaks to the overall success of what we created here in Pittsburgh,” says Dr. Schwartz. “And while UPMC Total Care-IBD is a specialized program for a subset of our IBD patients, its underlying principles are really an extension of how we view IBD as a disease and how best to manage this condition, particularly in complex cases where there are numerous compounding patient issues.”

The division has presented findings on the successes of UPMC Total Care-IBD since its inception, including fewer ER visits, less opiate use, and improved behavioral health measures. See below for a selection of references for further reading of the program’s work and accomplishments to date.

A Research Program With Few Equals

There are few IBD programs in the United States that are able to boast as robust and successful a research program as the UPMC IBD Center. National and international research leaders in the field of IBD – David G. Binion, MD, co-director of the IBD Center and head of the IBD Translational Research Program, and co-director Richard H. Duerr, MD, the IBD Genetics Research Chair – continue their work to more fully understand the causes and influences of IBD at the molecular, cellular, and tissue-level, and how to best translate new findings and therapeutic options at the bedside.

Dr. Binion’s “big” data work in IBD continues with his long-standing and powerful IBD Research Registry that continues to provide new insights and learnings for driving forward the search for biomarkers of disease, the impact of diet and nutrition on IBD, and ultimately how to use this information to optimize care at the individual level.

“From my perspective, there are very few IBD centers in the United States quite like ours. Our research faculty and teams are driven by the tandem goals of understanding fully the mechanisms of action in IBD and what we can do to improve upon care. Even if we can’t “cure” a person’s disease, how can we make it such that IBD becomes a minor impediment? It brings me great personal satisfaction to work with such a driven and diverse team,” says Dr. Schwartz. “Ultimately, our success can only be measured by how well our patients remain over their many years of living with a chronic and complex disease.”

Patient Referrals

The UPMC IBD Center welcomes patient referrals for complex and challenging cases. To refer a patient or contact one of the Center’s specialists, please call 866-442-7876. 

Learn more about the UPMC IBD Center and its leadership and care teams.