Can coordinated care help patients with high-risk IBD?

Inflammatory bowel disease, or IBD, affects nearly 3.1 million Americans. The condition includes Crohn's disease and ulcerative colitis and can be quite costly for its patients.

"Not only are the symptoms associated with IBD significant, the clinical outcomes linked to the treatment of this disease are, as well," said Jeffrey Berinstein, M.D., a gastroenterologist and clinical instructor at Michigan Medicine. "There is a lot of variation in how patients respond to specific forms of care, as well as high direct costs associated with the disease. IBD can be a very challenging condition to live with."

These factors inspired Berinstein and a team of fellow experts to examine if a more coordinated approach to health care could eventually alleviate the cost and symptom burdens associated with IBD. Their research was recently published in Clinical Gastroenterology and Hepatology.

"Our research really honed in on whether or not a strategy focused on improved care coordination, or the intentional delivery of patient care from interconnected providers, improved the burden of symptoms for patients with IBD and reduced their overall health care costs," said Berinstein. "And in order to do this, our study participants were patients with the condition in the top quintile of predicted health care utilization and costs." 

The team then used a randomized trial to assess how effective a patient-specific – yet multifaceted – care coordination plan for individuals with IBD was in lessening symptoms and cost. 

"We looked at patients with IBD that were randomized to 'usual care' or our care coordination 'intervention' over a nine-month period, from April of 2019 to January of 2020," said Berinstein. "Our care coordination intervention e was comprised of proactive symptom monitoring and specific care coordination triggered algorithms."

Berinstein notes that these electronic health record embedded questionnaires generated automated scores for each patient. The team would then use this patient-tailored information to tweak their care even further in hopes of meeting their personalized needs.

"If a patient was continuously having difficulty paying for their medications, for example, then we'd coordinate their care in such a way that they would speak with a social worker for help," said Berinstein. "And if someone was reporting high levels of anxiety and depression related to their condition, we'd recommend that they meet with a GI behavioral health specialist."

By taking these diverse 'scores' into consideration, Berinstein and his team were able to thoughtfully design care plans that benefited these high-risk IBD patients.

"We found that we were able to improve patient-reported symptom scores significantly yet found this low-cost and scalable approach didn't increase the overall cost for patient outcomes."

As Berinstein looks ahead, he hopes that this research will help inform a better and more cost-effective approach to caring for high-risk patients with IBD.

"Through our work we've been able to show that care coordination programs are an effective way to improve symptom scores without directly increasing the costs for individuals with this oftentimes debilitating condition."

Paper cited: "A Care Coordination Intervention Improves Symptoms But Not Charges in High-Risk Patients With Inflammatory Bowel Disease," Clinical Gastroenterology and Hepatology. DOI: 10.1016/j.cgh.2021.08.034

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