Impact of an Integrated Model of Care on Outcomes of Patients With Inflammatory Bowel Diseases: Evidence From a Population-Based Study. (2nd August 2017)

• Record Type: Journal Article
• Authors: Peña-Sánchez, Juan Nicolás; Lix, Lisa M; Teare, Gary F; Li, Wenbin; Fowler, Sharyle A; Jones, Jennifer L
• Is Part Of: Journal of Crohn's and colitis. Volume 11:Number 12(2017:Dec.)
• Page Start: 1471
• Page End: 1479
• Publication Date: 2017-08-02
• Subjects: Integrated delivery of health care -- Crohn's disease -- ulcerative colitis -- quality of health care -- health administrative data; Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjx106
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background and Aims: Studies evaluating the impact of integrated models of care [IMC] for inflammatory bowel disease [IBD] on disease-related outcomes are needed. We compared the risk of IBD-related outcomes and prescription medication claims between patients exposed and non-exposed to an IMC. Methods: A retrospective population-based matched cohort study was conducted between 2009 and 2015, using administrative health data of Saskatchewan, Canada. Patients aged 18+ years with a diagnosis of IBD were identified with a validated administrative definition. Cases were classified as exposed and non-exposed to the IMC for IBD and matched based on propensity scores and disease duration. IBD-related hospitalisations, surgeries, prescription medication claims, and corticosteroid dependency [CsDep] were measured. Cox and logistic regression models evaluated differences between the groups, estimating hazard [HRs] and odds [ORs] ratios with corresponding confidence intervals [CIs]. Results: In total, 2312 matched patients were included; 24.3% were exposed individuals. Compared with non-exposed, exposed patients had a lower risk of IBD-related surgeries [HR = 0.78, 95% CI 0.61–0.99], higher risk of prescriptions of immune modulators [HR = 1.68, 95% CI 1.42–1.99], and biologics [HR = 1.85, 95% CI 1.52–2.27], and a lower risk of 5-aminosalicylic acid prescriptions [HR = 0.81, 95% CI 0.69–0.95]. A lower risk of IBD-related hospitalisations among exposed ulcerative colitis [UC] patients [HR = 0.66, 95% CI 0.49–0.89] was identified in stratified analyses. The odds of CsDep among exposed UC patients was 0.39 [95% CI 0.15–0.98]. Conclusions: The observed differences in disease-related outcomes and use of steroid-sparing maintenance therapies between exposed and non-exposed individuals support the concept that enhanced quality of care can be achieved within IMC for IBD.