Reduced Unplanned Care and Disease Activity and Increased Quality of Life After Patient Enrollment in an Inflammatory Bowel Disease Medical Home
Reduced Unplanned Care and Disease Activity and Increased Quality of Life After Patient Enrollment in an Inflammatory Bowel Disease Medical Home
复制标题
DOI：
10.1016/j.cgh.2018.04.007
复制
发表时间：
2018-11-01
影响因子：
12.6
通讯作者：
Szigethy, Eva
中科院分区：
文献类型：
--
作者：
Regueiro, Miguel;Click, Benjamin;Szigethy, Eva
背景与目的：专科医疗之家（SMH）是一种新的医疗保健模式，由多学科团队和专家管理慢性病患者。作为大型综合支付者-提供者网络的一部分，我们组建了炎症性肠病 (IBD) SMH，并调查了其对医疗保健使用、疾病活动性和生活质量 (QoL) 的影响。方法：我们与大学合作，对参加 IBD SMH 的 322 名患者（58% 为女性；平均年龄为 34.6 岁；62% 患有克罗恩病；32% 接受过 IBD 手术）进行了回顾性分析匹兹堡医疗中心健康计划，从 2015 年 6 月到 2016 年 7 月。患者接受了至少 1 年的随访。我们评估了 SMH 入组前一年和入院后急诊科就诊和住院次数的变化。次要指标包括 IBD 活动评估和生活质量。 结果：与 IBD SMH 入组前一年相比，患者急诊就诊次数减少了 47.3% (P < .0001)，住院次数减少了 35.9% (P = .008)。在 IBD SMH 入组后的一年中，患者的 Harvey-Bradshaw 指数中位数得分（从 4 降至 3.5；P = .002）和溃疡性结肠炎活动指数中位数得分（从 4 降至 3；P = .0003）显着降低，生活质量有所提高（短炎症性肠病问卷得分中位数从 50 增加至 51.8；P < .0001）。当我们比较基线分数与入组后的分数时，最极端（最高和最低）四分位的患者改善最大。根据多变量回归分析，使用皮质类固醇（比值比 [OR]，2.72；95% CI，1.32-5.66；P = .007）或阿片类药物（OR，3.20；95% CI，1.32-7.78；P = .01）和低生活质量（OR，4.44；95% CI， 1.08-18.250；P = .04）在入组时与持续的急诊就诊和住院治疗显着相关。 结论：我们发现 IBD SMH 的开发是可行的，可以显着减少计划外护理和疾病活动，并提高入组后 1 年后患者的生活质量。
BACKGROUND & AIMS: Specialty medical homes (SMHs) are a new health care model in which a multidisciplinary team and specialists manage patients with chronic diseases. As part of a large integrated payer-provider network, we formed an inflammatory bowel diseases (IBDs) SMH and investigated its effects on health care use, disease activity, and quality of life (QoL).METHODS: We performed a retrospective analysis of 322 patients (58% female; mean age, 34.6 y; 62% with Crohn's disease; 32% with prior IBD surgery) enrolled in an IBD SMH, in conjunction with the University of Pittsburgh Medical Center Health Plan, from June 2015 through July 2016. Patients had at least 1 year of follow up. We evaluated changes in numbers of emergency department visits and hospitalizations from the year before vs after SMH enrollment. Secondary measures included IBD activity assessments and QoL.RESULTS: Compared to the year before IBD SMH enrollment, patients had a 47.3% reduction in emergency department visits (P < .0001) and a 35.9% reduction in hospitalizations (P = .008). In the year following IBD SMH enrollment, patients had significant reductions in the median Harvey-Bradshaw Index score (reduced from 4 to 3.5; P = .002), and median ulcerative colitis activity index score (from 4 to 3; P = .0003), and increases in QoL (median short inflammatory bowel disease questionnaire score increased from 50 to 51.8; P < .0001). Patients in the most extreme (highest and lowest) quartiles had the most improvement when we compared scores at baseline vs after enrollment. Based on multivariable regression analysis, use of corticosteroids (odds ratio [OR], 2.72; 95% CI, 1.32-5.66; P = .007) or opioids (OR, 3.20; 95% CI, 1.32-7.78; P = .01), and low QoL (OR, 4.44; 95% CI, 1.08-18.250; P = .04) at enrollment were significantly associated with persistent emergency department visits and hospitalizations.CONCLUSIONS: We found development of an IBD SMH to be feasible and significantly reduce unplanned care and disease activity and increase patient QoL 1 year after enrollment.