Director, Center for Digestive Health and Co-Director, Inflammatory Bowel Disease Program, Dartmouth Health’s Dartmouth Hitchcock Medical Center; Constantine and Joyce Hampers Professor of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
It’s been said that the apple doesn’t fall far from the tree. So, it’s probably no coincidence that inflammatory bowel disease (IBD) changemaker Dr. Corey Siegel was raised in a medical family that valued hard work, helping others, and driving change.
“My mom was a maverick as a nurse, and my dad was a doctor who really pushed novel ideas in his field, and his patients absolutely loved him,” said Dr. Siegel. “What really intrigued me were new ideas that would change the way we communicate with patients, and what can I do to change the way we deliver care.”
After being paired with pioneering IBD physician Dr. Richard MacDermott in medical school, he says he became passionate about the field of IBD.
“I loved the patient population. I found that this was an incredibly resilient group of people who dealt with a lot and were truly amazing.”
It was on Dr. MacDermott’s recommendation that Dr. Siegel do his residency at Dartmouth to work with leaders in evidence-based medicine. “He told me, ‘I want you coming out of residency more excited about medicine than when you went in,’” said Dr. Siegel, quoting his first mentor. “’Dartmouth is a great place to train. They’re great, thoughtful people.’”
Dr. Siegel’s chief insight early in his career was that the way practitioners delivered care to IBD patients needed to change. He saw the potential for improving the patient experience, and potentially changing outcomes in the process.
“In IBD, there’s diagnosing the problem and choosing the right treatment. And then there’s the way that you actually deliver that care,” said Dr. Siegel. “It’s about really getting people comfortable with their treatment plan. And I felt I could significantly improve that experience.”
One of Dr. Siegel’s first areas of focus was to strengthen shared decision-making by bringing the science of risk communication to the field of IBD. “It’s really important to make sure that people with IBD understand that risks of treatment are typically very small, while the risks of not treating the disease are really high,” he said.
“I really just wanted to help patients have a better experience in healthcare.”
With nobody working on how to really talk to patients about medications and risk, Dr. Siegel created a tool to facilitate these conversations. His risk palette is a simple graphic tool that visualizes the risks of side effects of different treatments to help patients better understand the risks.
To help people with Crohn’s disease understand the risks of foregoing treatment, Dr. Siegel developed a tool called CDPath in partnership with his wife, Lori — who holds a Ph.D. in environmental engineering and is an expert in modeling climate change — and Sherman Prize recipient Dr. Marla Dubinsky. CDPath predicts the risk of developing serious complications that may require surgery.
Both CDPath and the risk palette have been adopted widely, advancing shared decision-making by helping providers contextualize the risks of both disease and treatment to help reduce anxiety over side effects and increase adoption of effective medicines.
In his lifelong search to improve the quality of care, Dr. Siegel has found ways to multiply the impact of his work by involving others and providing insightful mentorship to expand the ranks of IBD specialists.
Nearly two decades ago when he was the first-ever IBD fellow at Massachusetts General Hospital under the mentorship of Drs. Bruce Sands and Josh Korzenik, he formed a network of IBD professionals to share best practices. That network grew over time and is now a top-tier panel of international experts called BRIDGe (Building Research in IBD Globally), which studies challenging areas of practice for which there are little to no existing data. BRIDGe meets annually and takes on some of the most controversial areas within IBD and formulates recommendations to help providers improve outcomes for their patients.
“We’ve built a website where IBD practitioners can input the individual characteristics of the patient or the scenario, and then it essentially tells you what the expert panel suggests you do in that situation. It’s a way to provide support when data are limited but you simply need to make a decision about patient management,” said Dr. Siegel.
Inspired by other medical quality improvement initiatives, he also co-founded a national quality improvement collaborative called IBD Qorus — a network of practices throughout the country. Today IBD Qorus encompasses more than 50 clinical sites.
“While others work on discovering new treatments and finding cures, let’s at least optimize what we’ve got now. But to do that, we have to change.”
“You can’t just say you’re giving good care and doing the best for patients,” said Dr. Siegel. “You have to measure it. Our idea was to learn from successes and failures by collecting patient-reported outcome data through a national network of institutions.”
Dr. Siegel, who acts as co-primary investigator with Dr. Gil Melmed in collaboration with the Crohn’s & Colitis Foundation, said the group has seen a significant decrease in emergency room visits, hospitalizations, and the use of steroids and opioids as a result — without dispensing any new medications or conducting any expensive clinical trials.
“These successes came from simply delivering care better,” said Dr. Siegel.
Dr. Siegel’s recent work is revolutionizing the way rural patients access quality care through an innovative program called RADIUS (Rural Advanced Practice Providers Delivering IBD Care in the United States).
Working in the only IBD center north of Boston and seeing patients who drove eight to 10 hours one way for a 30-minute visit, he resolved to find a better way and began experimenting with online ‘telemedicine’ back in 2013. When the COVID-19 pandemic hit, Dr. Siegel’s new model for healthcare delivery was already in place, which led to the RADIUS model where Dr. Siegel — along with IBD specialists in psychology, nutrition, pharmacy and nursing— act as a ‘hub’ to deliver quality care to rural patients in collaboration with their local providers. Nurse practitioners and physician assistants working in small community practices are central to this work.
“I’ve had the honor to mentor an incredible group nurse practitioners and physician assistants by co-managing patients and meeting with them regularly to discuss treatment plans. We really push each other to give these patients everything that they need and it’s been an amazing experience,” said Dr. Siegel. “The patients love it. The referring providers love it, and our team loves being part of RADIUS. We get a lot of positive feedback from all that are involved, and we are now spreading the program nationally.
“One provider told me they felt like they’d been on an island their whole career, but now they felt like they had an expert right in their back pocket.”
Despite all of these efforts, Dr. Siegel believes there is much to learn about the medications that we have now, and therapies yet to be introduced, and stands committed to making change as the field advances.
“We have brilliant scientists in IBD and they’ll no doubt continue to develop new drugs and make new discoveries. My goal is to be on the other end to figure out how to deliver these new therapies effectively. I think that’s where I can add the most value.”
