A Care Coordination Intervention Improves Symptoms But Not Charges in High-Risk Patients With Inflammatory Bowel Disease.
A Care Coordination Intervention Improves Symptoms But Not Charges in High-Risk Patients With Inflammatory Bowel Disease.
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DOI：
10.1016/j.cgh.2021.08.034
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发表时间：
2022-05
期刊：
影响因子：
--
通讯作者：
Higgins PDR
中科院分区：
文献类型：
--
作者：
Berinstein JA;Cohen-Mekelburg SA;Greenberg GM;Wray D;Berry SK;Saini SD;Fendrick AM;Adams MA;Waljee AK;Higgins PDR
炎症性肠病(IBD)与大量的症状负担、临床结果的可变性和高直接成本有关。我们试图确定基于护理协调的策略在改善患者症状负担和降低IBD患者的医疗成本方面是否有效，这些患者处于预测的医疗利用率和成本的前五分之一。我们进行了一项随机对照试验，以评估由主动症状监测和护理协调员触发的算法组成的患者定制的多组分护理协调干预的有效性。入选的IBD患者随机接受常规护理或我们的护理协调干预，为期9个月(2019年4月至2020年1月)。主要结果包括干预过程中患者症状评分的变化以及12个月时IBD相关费用的变化。符合条件的IBD患者被确定在预测的医疗利用和支出的前五分之一。205名患者随机分为我们的干预组(n=100)和常规护理组(n=105)。与常规护理相比，护理协调器组的患者的症状评分有所改善(系数−为0.68，95%CI，−1.18至−0.18；p=.008)，但与IBD相关的年医疗费用中位数(10,094美元对9,080美元，P=.322)没有显著差异。在这项由主动症状监测和护理协调员触发的算法组成的首个针对患者量身定制的护理协调干预的随机对照试验中，我们观察到患者症状评分的改善，但医疗费用没有改善。护理协调计划可能代表了一种有效的基于价值的方法，可以在不增加IBD高危患者亚组的直接成本的情况下改善症状评分。NCT04796571炎症性肠病(IBD)与巨大的症状负担和高昂的直接成本有关。有趣的是，只有不到10%的IBD患者占医疗费用的50%以上。对于具有高健康利用风险的IBD患者，结合主动症状监测和护理协调员触发算法的多组分干预是可行的。我们的干预措施在降低患者症状评分方面有效，但不能降低医疗费用。IBD中心可以利用集成的患者门户资源或低成本的网络平台，通过症状监测和护理协调员触发的算法来支持护理协调，从而在不增加IBD高危患者成本的情况下减轻症状负担
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. 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 (04/2019 – 1/2020). Primary outcomes included change in patient symptom scores throughout the intervention and IBD-related charges at 12 months. Eligible IBD patients in the top quintile for predicted healthcare utilization and expenditures were identified. 205 patients were enrolled and randomized to our intervention (n=100) or usual care (n=105). Patients in the care coordinator arm demonstrated an improvement in symptoms scores compared to usual care (coefficient −0.68, 95% CI, −1.18 to −0.18; p=.008) without a significant difference in median annual IBD-related healthcare charges ($10,094 vs $9,080, P=.322). 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 healthcare charges. Care coordination programs may represent an effective value-based approach to improving symptoms scores without added direct costs in a subgroup of high-risk patients with IBD. NCT04796571 Inflammatory Bowel Disease (IBD) is associated with substantial symptom burden and high direct costs. Interestingly, less than 10% of patients with IBD patients account for over 50% of healthcare expenditures A multicomponent intervention incorporating proactive symptom monitoring and care coordinator-triggered algorithms is feasible for patients with IBD at high risk for health utilization. Our intervention was effective at reducing patient symptoms scores but not healthcare charges. IBD centers can utilize integrated patient portal resources or low-cost web-platforms to support care coordination through symptom monitoring and care coordinator triggered algorithms to reduce symptom burden without increasing costs for high-risk patients with IBD
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影响因子：
4.4
作者：
Prenzler, Anne;Bokemeyer, Bernd;Mittendorf, Thomas
通讯作者：
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通讯作者：
D'Haens, Geert R.
影响因子：
120.7
作者：
Bodenheimer, T;Wagner, EH;Grumbach, K
通讯作者：
Grumbach, K