title: Effect of digestive health care services integration on resource use and outcomes in patients with digestive disorders.
abstract: OBJECTIVE
  Academic medical centers are under pressure to contain resources. The University of Virginia Digestive Health Service Center (DHSC) is a fully integrated inpatient service combining gastroenterology, hepatology, surgery, pathology, radiology, and nutritional services. The aim of this study was to evaluate whether integration of digestive health services can contain resource use among gastrointestinal (GI) inpatient admissions.
  
  
  METHODS
  This is a cohort study of 2934 inpatient cases admitted to a referral academic medical center between January 1, 1998, and June 30, 2000, with a primary diagnosis of an esophageal disorder, appendicitis, abdominal hernia, intestinal obstruction, diverticulitis, biliary tract disease, liver disease, a pancreatic disorder, or GI hemorrhage. Cases were grouped by admitting service (DHSC vs. other nonintegrated inpatient services). Total cost, length of stay, and 30-day readmission rate were adjusted for differences in baseline patient characteristics and compared.
  
  
  RESULTS
  DHSC admission was associated with significant cost savings (P = 0.0363) and reduced length of stay (P < 0.0001). Cost savings were attributable to patients admitted for liver disease (P = 0.0077), GI hemorrhage (P = 0.0031), and diverticulitis (P = 0.0497); reductions in length of stay were seen for patients with liver disease (P = 0.0314), GI hemorrhage (P = 0.0212), diverticulitis (P = 0.0017), esophageal disorders (P = 0.0006), and abdominal hernia (P = 0.0458). DHSC patients with pancreatic disorders had increased total cost (P = 0.0247), but no difference in length of stay (P = 0.7504) and a lower 30-day readmission rate (P = 0.0478).
  
  
  CONCLUSIONS
  Integration of digestive health services reduces resource use for patients with digestive diseases and may improve outcomes for patients with pancreatic disorders. A multidisciplinary service center may represent a more efficient model for health care delivery for these patients.
authors.affiliation: Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, Virginia 22908-0708, USA.
authors.forename: Kristen O
authors.initials: KO
authors.lastname: Arseneau
authors.forename: Paul
authors.initials: P
authors.lastname: Yeaton
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.forename: Fabio
authors.initials: F
authors.lastname: Cominelli
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000458:organization & administration*; D015331:Cohort Studies; D005762:Gastroenterology / Q000191:economics / Q000458:organization & administration*; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000628:therapy; D006748:Hospital Departments / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D016018:Least-Squares Analysis; D007902:Length of Stay; D017146:Models, Organizational; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018511:Systems Integration; D016896:Treatment Outcome; D014768:Virginia