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Structured Patient Care Improves Outcomes for IBD Patients

Cedars-Sinai Investigators Identify Best Practices That Can Lead to Healthcare Savings for Patients and Providers

Making simple changes in the way care is delivered to patients with inflammatory bowel disease (IBD) improves outcomes and reduces healthcare emergencies. These changes also lower the high cost of IBD patient care, according to two studies by Cedars-Sinai investigators.

Patients living with IBD often navigate a rollercoaster of disease flare-up and healthcare emergencies that can result in frequent visits to emergency departments, unplanned surgeries, and the increased use of prescription pain medications. Also, the healthcare costs for IBD patients are three times greater than those without the disease, according to research by the Crohn’s & Colitis Foundation.

In a quality improvement study, gastroenterologists at Cedars-Sinai found that standardizing the way care is managed for adults with IBD was associated with significant improvements in patient outcomes, including a reduction in visits to the emergency room, hospitalizations and the use of corticosteroids and opioids.

The study, “Quality of Care Program Reduces Unplanned Health Care Utilization in Patients With Inflammatory Bowel Disease,” is published in the American Journal of Gastroenterology.

“We looked at the impact of 19 specific process changes for managing the care of patients most likely to benefit from intervention. Those changes included improved access to clinic slots for urgent care needs, establishing rapid-access clinics, and proactively monitoring and contacting patients at high risk for problems in the management of their disease,” said Gil Melmed, MD, director of Inflammatory Bowel Disease Clinical Research at Cedars-Sinai and co-principal investigator of the multi-site quality improvement study.

Twenty-seven community-based gastroenterology practices and academic medical centers around the United States participated in the process-change program that involved 20,382 patient visits, according to Melmed. The project was done as part of IBD Qorus, a national research initiative of the Crohn’s & Colitis Foundation aimed at improving the quality of IBD patient care and outcomes. Cedars-Sinai is one of the participating centers of the initiative.

A companion study looked at the economic healthcare savings from implementing some of the “best practices” identified by IBD Qorus for the management of patient care. Results of the investigation were reported in the paper “Health Economic Impact of a Multicenter Quality-of-Care Initiative for Reducing Unplanned Healthcare Utilization Among Patients With Inflammatory Bowel Disease,” also published in the American Journal of Gastroenterology.

Healthcare expenditures for IBD patients in the United States are nearly $25 billion a year. Two-thirds of that cost is associated with disease-related emergency department visits and hospitalizations, according to data cited in the paper. Researchers performed a comprehensive decision analysis to assess the economic impact of interventions designed to reduce costly unplanned healthcare utilization.

“We showed that you don’t need fancy or expensive tools to avoid hospitalizations for patients with IBD. By simply changing the way we deliver care, we can avoid urgent, unplanned care, and on average save almost $2,500 per IBD patient each year,” said gastroenterologist Christopher Almario, MD, MSHPM, principal investigator of the economic impact  study.

“An example of a low-cost process change we looked at included maintaining a list of patients who are at high risk for needing emergency care or hospitalization and then following them closely. Another example was the use of weekly team huddles among the IBD clinicians and staff where they discussed how best to manage those high-risk patients,” said Almario, an assistant professor of Medicine at Cedars-Sinai.

Monthly webinars to review performance data were facilitated by a quality improvement adviser. Healthcare providers also shared the results of patient outcome measures at their sites, learning from one another as the study went along. 

“Those best practices employed at the sites have been distilled into an ‘Urgent Care Toolkit’ that is available, through the Crohn’s & Colitis Foundation, to all providers managing IBD patients,” said Melmed, senior author on the economic impact study.

Funding for work related to IBD Qorus was provided by the Crohn’s & Colitis Foundation.

Read more on the Cedars-Sinai Blog: Ancestry Matters:  Genetic Risk Factors for Inflammatory Bowel Disease (IBD)