简介:AIM:Tocombinecommunityandhospitalservicesinordertoenableimprovementsinpatientmanagement,anintegratedgastroenterologyservice(IGS)wasestablished.METHODS:Referralpatternstospecialistclinicswereoptimized;openaccessrouteforendoscopicprocedures(includingesophago-gastro-duodenoscopy,sigmoidoscopyandcolonoscopy)wasestablished;familyphysicians’knowledgeandconfidencewereenhanced;directcommunicationlinesbetweenexpertsandprimarycarephysicianswereopened.Continuingeducation,guidelinesandagreedinstructionsforreferralwerepromotedbytheIGS.SixqualityindicatorsweredevelopedbytheDelphimethod,rigorouslydesignedandregularlymonitored.Improvementwasassessedbycomparing2010,2011and2012indicators.RESULTS:Anintegrateddeliverysysteminaspecificmedicalfieldmayprovideasolutiontoafragmentedhealthcaresystemimpairedbyalackofcoordination.InthispaperwedescribeanewintegratedgastroenterologyserviceestablishedinApril2010.Waitingtimeforproceduresdecreased:3moinApril30th2010to3wkinApril30th2011andstayedbetween1-3wktillDecember30th2012.Averagecostforpatient’svisitdecreasedfrom691to638NIS(adecreaseof7.6%).Sixhealthindicatorswereimprovedsignificantlycomparing2010to2012,2.5%to67.5%:Bonedensitometryforpatientswithinflammatoryboweldisease,preventivemedicationsforhighriskpatientsonaspirin/NSAIDs,colonoscopyfollowingpositivefecaloccultbloodtest,gastroscopyinBarrett’sesophagus,documentationoffamilyhistoryofcolorectalcancer,andcolonoscopyinpatientswithafamilyhistoryofcolorectalcancer.CONCLUSION:EstablishmentofanIGSwasfoundtoeffectivelyimprovequalityofcare,whilebeingcosteffective.