Improved Outcomes With Value-Based Care Program for IBD

One year after implementation, a value-based health care (VBHC) program for patients with inflammatory bowel disease (IBD) showed less use of steroids, imaging studies, emergency room visits and hospitalizations, and increased biomarker testing compared with a cohort of matched IBD patients treated by other academic gastroenterologists.

“We found encouraging trends toward less emergency department visits, hospitalizations, and long-term corticosteroid use,” said Welmoed K van Deen, MD, University of Southern California Gehr Family Center for Implementation Science, Los Angeles, CA, who presented the findings at Digestive Diseases Week 2016 (May 21-24, 2016; San Diego, CA).

The study included 98 patients with IBD who received treatment within the VBHC program. Key components of the program included evidence-based care pathways, care coordination, task differentiation, and remote monitoring.

To assess the performance of the VBHC program on IBD management, the investigators looked at specific outcomes (medication use, office visits, IBD-specific tests, emergency room visits, and hospitalizations) in participants and compared them with a cohort of 293 controls matched by comorbidities, IBD subtype, age, and relapse rate.

In this first analysis of the data at 1 year, the researchers found that patients treated through the VBHC program used 52% fewer corticosteroids, 77% fewer long-term corticosteroids, 6% more biologics, and 22% more immunomodulators. 

In addition, patients in the VBHC program underwent more biomarker testing (36% increase in C-reactive protein testing, 6% increase in erythrocyte sedimentation rate testing, and 7% increase in calprotectin testing) while undergoing fewer imaging studies (26% fewer computed tomography scans, 28% fewer magnetic resonance imaging scans, and 50% fewer ultrasound scans).

Lastly, patients in the VBHC program had a 20% increase in IBD-related office visits (but a decrease by 12% in overall office visits); a 40% decrease in surgeries; a 43% decrease in hospitalizations; and a 66% decrease in emergency room visits.

However, Dr van Deen also pointed out that none of the benefits seen with the VBHC program were statistically significant, probably due to the small sample size. As such, she emphasized the need to confirm the results in a larger sample with longer follow-up.

Although the results were preliminary, Dr van Deen said she wanted to share the results to show what implementing such a program looks like.

“The results look very promising, and I think it is important to share these data with each other to further the knowledge about the utility of clinical programs like this,” she added. —Mary Beth Nierengarten