Clinical Centers of Excellence: Gastrointestinal Disorders

Digestive system symptoms are responsible for an estimated 35.9 million office visits annually, according to the Centers for Disease Control and Prevention. These include approximately 14.5 million US adults diagnosed with ulcers, 7.95 million seeking help for constipation, and about 16 million annually who complain of abdominal pain, cramps, and spasms.

Gastrointestinal disorders encompass some of the most ordinary difficulties and some of the most ominous--pancreatic and liver cancers. Many of these patients require a referral and therefore, GI programs are this month's Clinical Centers of Excellence.

"I'd say 15 to 20 percent of my patients have some sort of GI complaint," says Salvatore Volpe, MD, of his internal medicine and pediatric practice in Staten Island, New York. For him, urgent GI referrals include Guaiac-positive stool tests, gallstones requiring endoscopic retrograde cholangiopancreatography, upper or lower GI bleeding, and newly diagnosed hepatitis B and C.

The centers we feature have active research protocols in diverse GI areas. These profiles provide physicians with a valuable tool when considering where to refer patients for diagnostic procedures and treatment of intractable, chronic GI disorders or serious disease.

Medical Economics editors have also gathered management and referral tips from the experts associated with the featured centers that may be useful when encountering some of the more common GI disorders in the primary care setting.

The GI centers were chosen based on a survey of gastroenterologists and were asked to provide patient statistics, research protocols and funding, GI areas of concentration, and information on other pertinent services.

We do not rank the centers relative to each other, but highlight what makes each one unique. We could not profile them all, but have included a list of the other Clinical Centers of Excellence identified by our surveys (see list, below).

Clinical Centers of Excellence

• Brigham and Women's Hospital,Boston, Massachusetts
• Cedars-Sinai Medical Center,Los Angeles, California
• Cleveland Clinic,Cleveland, Ohio
• Duke University Medical Center,Durham, North Carolina
• Johns Hopkins Hospital,Baltimore, Maryland
• Massachusetts General Hospital,Boston, Massachusetts
• Mayo Clinic,Rochester, Minnesota
• Mount Sinai Medical Center,New York, New York
• New York-Presbyterian Hospital,New York, New York
• Penn Medicine,Philadelphia, Pennsylvania
• University of California, San Francisco Medical Center,San Francisco, California
• University of Chicago Medical Center,Chicago, Illinois

Advanstar Clinical Centers of Excellence

Institutions under consideration to be named Clinical Centers of Excellence are asked to self-report data, which is checked against publicly available information. Depending on the specialty, these criteria may include:

• Quality-improvement initiatives under way
• Community outreach
• National awards and recognition
• Participation in national therapeutic initiatives (e.g., the National Cancer Consortium, Children's Oncology Group, etc.)
• Number of referrals for the particular specialty area
• Number of international referrals
• Number of patients treated/procedures performed per year
• Number of research protocols engaged in annually
• Number of medication/surgical errors
• Systems in place to prevent errors
• Outcomes data (e.g., mortality/morbidity rates, unnecessary readmission rates, etc.)
• Level of technological equipment on site
• EHR processes and level of development
• Participation in regional systems integration initiatives
• Follow-up care programs (e.g., enforcement of secondary prevention/medication compliance)
• Patient education efforts
• Patient satisfaction survey results
• Infectious disease prevention efforts
• Availability of comprehensive care programs (e.g., preventive cardiology)
• Evidence of incorporating research and clinical care
• High ranking by NCQA
• KOL publishing records
• Medical Nobel Laureates on faculty
• JCAHO certification/accreditation