Clin Gastroenterol Hepatol. 2022 May;20(5):1029-1038.e9.doi: 10.1016/j.cgh.2021.08.034. Epub 2021 Aug 28.

Jeffrey A Berinstein ¹, Shirley A Cohen-Mekelburg ², Gillian M Greenberg ³, Daniel Wray ⁴, Sameer K Berry ⁵, Sameer D Saini ², A Mark Fendrick ⁶, Megan A Adams ², Akbar K Waljee ², Peter D R Higgins ⁵

Author information

¹Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan. Electronic address: jberinst@med.umich.edu.

²Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.

³Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.

⁴Twine Clinical Consulting, Park City, Utah.

⁵Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan.

⁶Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, Michigan.

Abstract

Background: Inflammatory bowel disease (IBD) is associated with substantial symptom burden, variability in clinical outcomes, and high direct costs. We sought to determine if a care coordination-based strategy was effective at improving patient symptom burden and reducing healthcare costs for patients with IBD in the top quintile of predicted healthcare utilization and costs.

Methods: We performed a randomized controlled trial to evaluate the efficacy of a patient-tailored multicomponent care coordination intervention composed of proactive symptom monitoring and care coordinator-triggered algorithms. Enrolled patients with IBD were randomized to usual care or to our care coordination intervention over a 9-month period (April 2019 to January 2020). Primary outcomes included change in patient symptom scores throughout the intervention and IBD-related charges at 12 months.

Results: Eligible IBD patients in the top quintile for predicted healthcare utilization and expenditures were identified. A total of 205 patients were enrolled and randomized to our intervention (n = 100) or to usual care (n = 105). Patients in the care coordinator arm demonstrated an improvement in symptoms scores compared with usual care (coefficient, -0.68, 95% confidence interval, -1.18 to -0.18; P = .008) without a significant difference in median annual IBD-related healthcare charges ($10,094 vs $9080; P = .322).

Conclusions: In this first randomized controlled trial of a patient-tailored care coordination intervention, composed of proactive symptom monitoring and care coordinator-triggered algorithms, we observed an improvement in patient symptom scores but not in healthcare charges. Care coordination programs may represent an effective value-based approach to improve symptoms scores without added direct costs in a subgroup of high-risk patients with IBD. (ClinicalTrials.gov, Number: NCT04796571).