Pennsylvania native Miguel Regueiro, MD, isn’t just a gastroenterologist ― he’s a natural builder. At the University of Pittsburgh Medical Center (UPMC), he built its Inflammatory Bowel Disease (IBD) program from 50 patients and one physician (himself) into a comprehensive clinical and research program with seven IBD specialists, plus clinical nurses, research nurse coordinators, colorectal surgeons and a multispecialty team of support personnel, who cared for more than 11,000 patients.
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Moreover, he had flipped convention on its ear by restructuring the program as a patient-centered medical home for IBD.
But after a conversation with Digestive Disease & Surgery Institute Chairman Conor Delaney, MD, PhD, he saw opportunities to build on the concept here.
“Dr. Delaney’s vision, and that of Cleveland Clinic overall, was aligned with my interests,” says Dr. Regueiro. “Their desire to build a team to develop clinical programs that feed research and education resonated with me.”
He was struck by learning that the concept of a patient-centered medical home has been in Cleveland Clinic’s culture since its inception. “They were interested in having me reimagine the program for IBD patients and expanding this alternative model of care to other specialties within the Digestive Disease & Surgery Institute,” he says.
An outside-the-box concept
Dr. Regueiro’s interest in creating a medical home for patients with IBD came from conversations with his own patients. “The most important person in our relationship is the patient. It’s about what they want from the care experience, not about what we want. Turns out that what we were doing as healthcare providers was not patient-centric, and we had a lot to learn from the most important ‘stakeholders’ — our patients and their families.” he says.
The core of the problem, he says, is that the management of IBD has traditionally been segmented, lacks continuity and does not sufficiently address chronic pain and psychosocial symptoms.
To prevent “siloed” care, he felt a new model was needed, a model that would manage patients with an integrated team of providers levered through a payer-provider partnership. That led him to create a multispecialty team that would provide one-stop shopping for IBD patients. In a single clinic visit, patients see a gastroenterologist, nurse, dietitian, social worker and psychiatrist, have their status entered in a database and get a surgical consult, if necessary.
“The idea is to provide comprehensive care in an efficient manner, with minimal disruption to a patient’s life and personal schedule,” he says.
Between visits, ongoing care is offered through remote monitoring and telemedicine connections. For patients with the most need, nurses and social workers provide home visits.
Building on success
At Cleveland Clinic, Dr. Regueiro plans to continue building programs that deliver whole-person, patient-centered care for chronic diseases using a multispecialty, population-health approach, starting with IBD. “My interests and research lie in how medicine and surgery interface in Crohn’s, and specifically the post-operative Crohn’s disease model,” he says.
He will also apply lessons learned to liver, obesity, metabolic and functional bowel diseases and other specialties of GI and hepatology. “I hope to ensure the members of all departments within the DDSI are integrated into a cohesive, well-function team,” he says.
In the process, patient flow will be restructured so that routine patients are treated in select regional hospitals, and the most complex cases are handled on Cleveland Clinic’s main campus.
To support existing research in GI and hepatology, Dr. Regueiro plans to expand clinical research and formalize a clinical trials team. He would like to see each service line have a prospective registry, and he will encourage big data analysis and outcomes research that links to translational science and personalized medicine.
“I would also like to develop research in healthcare economics and design population health and epidemiology studies,” he says. “As our healthcare delivery evolves new models of care that are reliant on integration of providers, payers, industry, innovative technology and patients, we will have an opportunity to write a new ‘healthcare playbook.’ To do this, understanding the economic impact of these models, and how regional and national patient populations are cared for, are at the core of next-generation medicine.”
Innovation in education
His plans for growing the department’s already excellent education programs include integrating his Inflammatory Bowel Disease Live Interinstitutional and Interdisciplinary Videoconference Education (“IBD Live”) series with Cleveland Clinic. This virtual weekly IBD meeting currently attracts 200 physicians from throughout the U.S.
He plans to work with department educators to develop other innovative educational programs that span the entire physician and healthcare educational experience, from medical students to residents, fellows and practicing clinicians.
Finally, recognizing that on May 14 he stepped into a department staffed with world-class physicians, staff, researchers and educators, Dr. Regueiro pledges to provide them with the necessary support to continue on their path of excellence.
“I will work with each member of the Department of Gastroenterology and Hepatology to ensure there is an opportunity to achieve career goals and advance the mission of the institute, without sacrificing quality of life,” he says.