title: Interprofessional collaborative care reduces excess service utilization among individuals with chronic pancreatitis.
abstract: BACKGROUND
  Pain is common and multifactorial among patients with chronic pancreatitis. Underrecognized and undertreated psychosocial comorbidity can exacerbate pain experience. Excess inpatient service utilization within this patient population prompted a performance improvement initiative at a large academic medical center.
  
  
  METHODS
  An interprofessional treatment approach with programmatic medical, surgical, and psychological and psychiatric interventions was rolled-out in January 2007 and length of stay (LOS) was measured on a quarterly basis for a 2-year period. Trends in resource utilization (LOS, estimated opportunity costs) were assessed with a novel modified bootstrapping technique, Simulation Modeling Analysis (SMA).
  
  
  RESULTS
  From January 1, 2007, through December 31, 2008, SMA revealed a linear downward trend in LOS (ρ = -0.857, p = .0170), and the interprofessional treatment approach was associated with estimated opportunity cost savings of $670,750.27. There were no associated changes in 7-, 14-, and 30-day readmission rates, p > .05.
  
  
  CONCLUSIONS
  Interprofessional care that combines behavioral approaches to pain management; behavioral contingency management for opioid medication management; psychological and psychotropic treatments for depression, anxiety, and addiction in addition to standard medical and surgical treatments for pancreatitis appears to be associated with lower healthcare costs. Future research should examine patient reported outcomes of this model.
authors.affiliation: Department of Psychiatry&Behavioral Sciences, Manager of Quality&Outcomes for the Mental Health Service Line, Medical University of South Carolina, USA. madana@musc.edu.
authors.forename: Alok
authors.initials: A
authors.lastname: Madan
authors.forename: Jeffery J
authors.initials: JJ
authors.lastname: Borckardt
authors.forename: Kelly S
authors.initials: KS
authors.lastname: Barth
authors.forename: Joseph
authors.initials: J
authors.lastname: Romagnuolo
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Morgan
authors.forename: David B
authors.initials: DB
authors.lastname: Adams
mesh_terms: D000046:Academic Medical Centers; D003299:Cooperative Behavior; D003953:Diagnosis-Related Groups; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007400:Interprofessional Relations; D007902:Length of Stay / Q000639:trends; D059408:Pain Management / Q000706:statistics & numerical data*; D050500:Pancreatitis, Chronic / Q000628:therapy*; D010359:Patient Readmission / Q000639:trends; D013022:South Carolina
keywords: chronic pancreatitis; healthcare cost; interprofessional care; service utilization