Impact of Care in an Interdisciplinary Inflammatory Bowel Disease Specialty Clinic on Outcomes in Patients Insured with Medicaid.
Impact of Care in an Interdisciplinary Inflammatory Bowel Disease Specialty Clinic on Outcomes in Patients Insured with Medicaid.
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跨学科炎症性肠病专科诊所的护理对医疗补助投保患者的结果的影响。
DOI：
10.1097/mcg.0000000000001769
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发表时间：
2023
影响因子：
2.9
通讯作者：
Rao,BhavanaB
中科院分区：
文献类型：
--
作者：
Wang,ChristinaP;Zylberberg,HaleyM;Borman,ZacharyA;Engelman,Sally;Yanes,Ricardo;Hirten,RobertP;Sands,BruceE;Cohen,BenjaminL;Ungaro,RyanC;Rao,BhavanaB
背景：众所周知，炎症性肠病（IBD）患者受益于在专业的跨学科环境中提供的护理。我们的目的是评估这种模式对健康结果的影响，质量指标，和医疗保健资源利用（HRU）在IBD患者投保Medicaid.Materials and Methods：在2017年7月，IBD患者在我们的三级医院从一个研究员的普通胃肠病（GI）诊所过渡到一个研究员的跨学科IBD诊所。IBD患者如果参加了医疗补助保险，在2016年7月1日至2017年6月30日期间在普通GI诊所至少有1次就诊，并且在2017年7月1日至2018年6月30日期间在IBD诊所至少有1次就诊，则被纳入。与患者IBD病程、总体健康护理维护和HRU相关的特征进行了比较。结果：共纳入170例患者（51%为男性，平均年龄39岁）。过渡到IBD诊所后，皮质类固醇（37% vs. 25%; P= 0.004）和联合治疗的使用显著降低（55% vs. 38%; P= 0.0004），尽管高剂量生物制剂的使用在数值上增加（58.5% vs. 67%; P= 0.05）。转换后，患者的平均C反应蛋白水平显着降低（P= 0.04）。在过渡期后，患者参加的门诊GI访视明显减少（P= 0.0008），但更常见于其他医疗保健专家（P= 0.0003），并经历了一个数字减少HRU与急诊科就诊，住院，和surgics.Conclusions：护理在一个跨学科，IBD专业设置与显着减少皮质类固醇的使用，降低C-反应蛋白水平，并改善获得辅助服务的医疗补助患者。
Background:Inflammatory bowel disease (IBD) patients are known to benefit from care delivered in a specialized, interdisciplinary setting. We aimed to evaluate the impact of this model on health outcomes, quality metrics, and health care resource utilization (HRU) in IBD patients insured with Medicaid.Materials and Methods:In July 2017, IBD patients at our tertiary hospital were transitioned from a fellows’ general gastroenterology (GI) clinic to a fellows’ interdisciplinary IBD clinic. IBD patients were included if they were insured with Medicaid, had at least 1 visit in the general GI clinic between July 1, 2016 and June 30, 2017, and at least 1 visit between July 1, 2017 and June 30, 2018 in the IBD clinic. Characteristics related to patients’ IBD course, overall health care maintenance, and HRU were compared.Results:A total of 170 patients (51% male, mean age 39 y) were included. After the transition to the IBD clinic, use of corticosteroids (37% vs. 25%; P= 0.004) and combination therapy were significantly lower (55% vs. 38%; P= 0.0004), although use of high-dose biologics numerically increased (58.5% vs. 67%; P= 0.05). Posttransition, patients showed significantly lower levels of mean C-reactive protein (P= 0.04). After the transition, patients attended significantly fewer outpatient GI visits (P= 0.0008) but were more often seen by other health care specialists (P= 0.0003), and experienced a numeric decrease in HRU with fewer emergency department visits, hospitalizations, and surgeries.Conclusions:Care in an interdisciplinary, IBD specialty setting is associated with significantly decreased corticosteroid use, decreased C-reactive protein levels, and improved access to ancillary services in Medicaid patients.
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