Heartburn Center Set-Up in a Community Setting: Engineering and Execution

Area of Science:

• Gastroenterology
• Surgical Management
• Health Services Research

Background:

• Optimal gastroesophageal reflux disease (GERD) management necessitates a multidisciplinary team approach, moving beyond individual physician efforts.
• Previous proposals for integrated GERD care lacked practical implementation details, especially within community healthcare settings.
• A 'center of excellence' (COE) model offers comprehensive care from initial diagnosis to surgical intervention for complex GERD cases.

Purpose of the Study:

• To describe the implementation of an integrated heartburn center (HBC) in a community setting.
• To evaluate the clinical and operational outcomes of the HBC over a 2-year period.
• To assess the impact of the HBC on patient referral patterns, treatment, and quality of life.

Main Methods:

• Established an integrated heartburn center (HBC) for comprehensive GERD patient management.
• Tracked patient journeys for 2 years, including diagnosis, treatment, and post-surgical outcomes.
• Compared key performance indicators (KPIs) such as patient volume, referral sources, length of stay (LOS), and health-related quality of life (HRQL) pre- and post-HBC implementation.

Main Results:

• The HBC saw a 75% increase in patient referrals from diverse sources (PCPs, EDs, GIs).
• A significant proportion of patients presented with long-standing GERD (1-11 years or ≥12 years), atypical symptoms, and comorbidities like chronic pulmonary disease and diabetes.
• Despite increased referrals, anti-reflux surgery conversion rates remained stable (~25%), HRQL improved, and LOS was reduced, indicating potential cost savings.

Conclusions:

• Centralizing GERD care in a community setting via an integrated service line is clinically successful and commercially viable.
• The HBC model provides a reproducible, coordinated, multi-specialty, patient-centered approach to GERD management.
• This initiative strengthens patient-community relationships and establishes leadership in GERD scientific and clinical practice.