Abstract

A Care Coordination Intervention Improves Symptoms But Not Charges in High-Risk Patients With Inflammatory Bowel Disease

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

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