- Email: [email protected]
Mo1864 Current Trends in the Quality of Care of Inflammatory Bowel Disease in the United States
Mo1866 Factors Associated with Pregnancy-Related Knowledge in Reproductive-Aged Women with Inflammatory Bowel Disease Ko Eun Lee, Sung-Ae Jung, Hyuk Yoon, Sang Hyoung Park, Chang Mo Moon, Eun Soo Kim, Seong-Eun Kim, Suk-Kyun Yang Number of Hospitalizations by IBD activity, Quality of Life, and Complexity Scores
Background: Inflammatory bowel disease(IBD) onset usually occurs at young age and women experience marriage, pregnancy, and delivery during the disease progress. However, a questionnaire study in Australia reported that 45% of women with IBD showed poor knowledge. The aim of this study was to evaluate pregnancy-related knowledge of women with IBD in Korea and investigate the associated factors. Methods: A questionnaire was performed on 270 women with IBD ranging from 19 to 45 years old from 4 tertiary hospitals in Korea. A total of 17 questions from validated Crohn's and Colitis Pregnancy Knowledge Score(CCPKnow) was translated into Korean with permission from the original author. The results was classified into 4 categories according to the score: poor(0-7); adequate(8-10); good(11-13); very good(14-17), and adequate or higher was considered proper knowledge level. The correlation between the knowledge level and baseline characteristics, disease and drug history, thoughts about pregnancy was analyzed. Results: The average score of CCPKnow for 270 subjects was 7.47±3.07. The proportion of each category was 51.5%(poor), 30.4%(adequate), 17.0%(good), and 1.1%(very good). Patients with Crohn's disease(65.1%) had better knowledge than ulcerative colitis(39.5%, p=0.011). The proportion of proper level of knowledge was significantly higher in patients with longer disease duration(>5 years, 57.8% vs £5 years, 37.8%, p=0.001), anti-TNF-a therapy(64.0% vs 41.3%, p=0.001), higher income(‡USD 2000, 50.8% vs
Mo1864 Current Trends in the Quality of Care of Inflammatory Bowel Disease in the United States Arun Swaminath, Marla Dubinsky, Naijun Chen, Martha Skup, Jingdong Chao, Anthony Wang Introduction: Quality of care assessment has become a central part of the health care landscape due to widespread concern over patient safety and the value of care.1 A particular area of concern is the use of steroids to manage IBD patients despite the recommendation by IBD treatment guidelines to avoid long-term management with steroids.2,3 Methods: A retrospective cohort analysis using the Commercial and Medicare Truven Health MarketScan® Databases was conducted 7/1/2013-6/30/2014. The inclusion criteria were age ‡18 years and continuous enrollment during study period. The level of IBD detection [Numerator: Adult IBD patients with an inpatient or outpatient visit; Denominator: All patients meeting inclusion criteria] was calculated to describe the prevalence of IBD within the database. Quality of care metrics calculated include 1) % of IBD patients seen/treated by gastroenterologists [Numerator: IBD patients with a gastroenterologist visit on or after the first IBD diagnosis date during the study period; Denominator: All IBD patients] and 2) % of IBD patients who were not prescribed steroid-sparing therapy (SST) (eg, immunomodulators or biologics) despite being prescribed long-term steroid therapy (LST) ( ‡10mg/day for ‡60 consecutive days or 1 prescription of ‡600mg of steroids) [Numerator: IBD patients prescribed LST but not SST; Denominator: IBD patients prescribed LST]. Results: Within the database, 0.60% (118,500/19,728,701) of patients had IBD diagnoses. States with highest IBD detection were Rhode Island (0.88%), Connecticut (0.84%), and New York (0.80%). States with lowest detection were New Mexico (0.35%), Hawaii (0.41%), and Mississippi (0.43%). Nationally, 66.25% (78,501/118,500) of IBD patients had visited a gastroenterologist on or after the date of IBD diagnosis. States with highest % of patients with gastroenterologist visits were Delaware (79.15%), Washington, DC (76.19%), and Georgia (75.79%). States with lowest % were Mississippi (36.06%), Wyoming (45.16%), and Hawaii (45.45%). Of IBD patients who were managed on long-term steroids in this study, 51.32% (9,211/17,948) were not prescribed an SST. States with highest LST without SST were Wyoming (64.29%), Oklahoma (64.19%), and Montana (62.50%). Lowest rates were South Dakota (33.33%), Nebraska (35.14%), and New Mexico (41.18%). Conclusion: This study provides evidence that there is variability across states in the quality of IBD care and that IBD patients are currently often managed with long-term steroid therapy. These findings indicate that there is a need to better align treatment patterns to IBD treatment guidelines. References: 1. Committee on Quality of Health Care in America. Crossing the quality chasm. National Academies Press; 2001 2. Lichtenstein GR, et al. Am J Gastroenterol. 2009;104:465-83 3. Kornbluth A, Sachar DB. Am J Gastroenterol. 2010;105:501-23
Mo1867 Emergency Department Healthcare Utilization among IBD Patients at an Academic Tertiary Care IBD Referral Center Michelle Vu, Jennifer Phan, Christina Ha Background: Although trends in emergency department (ED) visits by IBD patients have been evaluated, there is a paucity of data regarding resource utilization for IBD management in the ED. We aim to identify features of Crohn's disease (CD) patients presenting to the ED and to assess for potential contributors to the high cost of IBD care in the ED. Methods: We performed a retrospective cohort study of patients with a confirmed diagnosis of CD presenting to the ED of a tertiary care IBD referral center between 3/2013 and 7/2014. Variables of interest included presenting symptoms, ED diagnostic evaluation and therapeutics, predictors of admission and post-ED visit follow-up. Results: 103 CD patients presented to the ER 175 times during the 17-month study period. 57% of patients were female, mean age was 45.6 + 18.5 years old. The most common presenting complaint was abdominal pain (n=114, 65%), followed by nausea/vomiting (13.7%), fever (8.6%), GI bleeding (8%) and diarrhea (8%). Patients who presented with abdominal pain were more likely to have a CT scan in the ED compared to patients who presented with non-pain related complaints (50.4% vs. 33.9%, p=0.04), and they also were more likely to receive narcotics in the ED (73.5% vs. 33.9%, p<0.0001). Abdominal pain on presentation was not a predictor of subsequent steroid administration in the ER, and was a negative risk factor for inpatient admission compared to those non-pain related complaints (55.8% vs. 83.9%, p=0.04). Regardless of the presenting symptom, gastroenterology (GI) follow-up after ED presentation was low (40%) for the CD patients, and a GI consult was only called for 21% of the visits. Patients who were a part of an IBD program were more likely to have post-ER follow up compared to those who were not part of an IBD program (57.1% vs. 30.3%, p=0.007). 36 CD patients had multiple ER visits during this study period, accounting for 107 of 175 of total ER visits (61.6%). This sub-group had multiple CT scans performed (n=11, 30.6%), multiple narcotic prescriptions (n=22, 61.1%), and multiple hospital admissions (n=22, 61.1%). Only 14 (38.9%) had an established GI physician and 16 (44.4%) had an outpatient GI follow up post-ED visit. Patients without an IBD physician accounted for 71.1% of the multiple ER visits. Conclusion: CD patients presenting with abdominal pain to the ED were more likely to have CT scans, narcotics, and frequent encounters, but were not more likely to require admission. There was a low rate of post-ED follow-up for CD patients, which may be contributing to increased ED and healthcare utilization. The majority of ED encounters were from a subgroup of patients without an established IBD physician. Our findings
Mo1865 Patient Reported Outcomes in a managed care Project With Inflammatory Bowel Disease Patients in Germany: CEDnetz-Study Bernd Bokemeyer, Jana Langbrandtner, Petra Jessen, Jürgen Büning, Stefan Schreiber, Heiner Raspe, Angelika Hueppe Background: IBD-patients experience various somatic and psychosocial impairments. They need a comprehensive, interdisciplinary and problem-oriented health care. To improve their quality of health care IBD-pathways recommend a systematic assessment of health-related problems and focus on a multidisciplinary, patient-centered care. In a prospective controlled cohort study German gastroenterologists tried to optimize their quality of care by network activities. The impact on patient reported outcomes was evaluated. Methods: In a region of North Germany 15 gastroenterologists recruited outpatients with IBD (IG: intervention group), outside this region 18 gastroenterologists included nationwide IBD-patients in a control group (CG). At baseline (t0), 6 (t1) and 12 months (t2) patients completed a questionnaire assessing 22 somatic and psychosocial problems. IG-patients received written feedback of their problem-profile together with individualized recommendations for appropriate treatment. Further IG-interventions were the implementation of interdisciplinary IBDcase conferences and the offer of a group-based patient education program. Main outcomes were health related quality of life (HRQoL: EQ-VAS, score: 0-100) and social participation restrictions (IMET, score: 0-10); self-management skills (heiQ) were among the secondary outcomes. Results: 282 of 349 IBD-patients (80.8%; IG: 142 of 189; CG: 140 of 160) participated in both follow-up visits. Baseline characteristics were broadly similar (age: 43 years; 61% female; 50% with Crohn's Disease; 66% in remission; 68% in full- or part time employment). Covariance analyses were used to adjust for baseline differences. No significant differences between IG and CG were seen at follow-up with respect to the primary outcomes,
S-799
AGA Abstracts
AGA Abstracts
the entire group showed small improvements from t0 to t2 (EQ-VAS: 72.5 to 76.2; IMET: 2.1 to 1.9). After 12-months only the IG reported increased self-management skills (heiQ), the CG remained nearly unchanged. In the IG "Self monitoring and Insight" and "Constructive Attitudes and Approaches" as subscales of heiQ showed a significant improvement (p=0.004 and p=0.010), and "Emotional well-being" a tendencial improvement. Conclusion: Our complex intervention could not be proved as effective in the primary outcomes. Nevertheless in the secondary outcomes (self-management skills-heiQ) we found an advantage for the IC. The missing differences between IG and CG could be partially explained by the fact, that not all network activities in the IG could have been realised in the aimed frequency. Further (sub group) analysis will promote the discussion.
Background: Inflammatory bowel disease(IBD) onset usually occurs at young age and women experience marriage, pregnancy, and delivery during the disease progress. However, a questionnaire study in Australia reported that 45% of women with IBD showed poor knowledge. The aim of this study was to evaluate pregnancy-related knowledge of women with IBD in Korea and investigate the associated factors. Methods: A questionnaire was performed on 270 women with IBD ranging from 19 to 45 years old from 4 tertiary hospitals in Korea. A total of 17 questions from validated Crohn's and Colitis Pregnancy Knowledge Score(CCPKnow) was translated into Korean with permission from the original author. The results was classified into 4 categories according to the score: poor(0-7); adequate(8-10); good(11-13); very good(14-17), and adequate or higher was considered proper knowledge level. The correlation between the knowledge level and baseline characteristics, disease and drug history, thoughts about pregnancy was analyzed. Results: The average score of CCPKnow for 270 subjects was 7.47±3.07. The proportion of each category was 51.5%(poor), 30.4%(adequate), 17.0%(good), and 1.1%(very good). Patients with Crohn's disease(65.1%) had better knowledge than ulcerative colitis(39.5%, p=0.011). The proportion of proper level of knowledge was significantly higher in patients with longer disease duration(>5 years, 57.8% vs £5 years, 37.8%, p=0.001), anti-TNF-a therapy(64.0% vs 41.3%, p=0.001), higher income(‡USD 2000, 50.8% vs
Mo1864 Current Trends in the Quality of Care of Inflammatory Bowel Disease in the United States Arun Swaminath, Marla Dubinsky, Naijun Chen, Martha Skup, Jingdong Chao, Anthony Wang Introduction: Quality of care assessment has become a central part of the health care landscape due to widespread concern over patient safety and the value of care.1 A particular area of concern is the use of steroids to manage IBD patients despite the recommendation by IBD treatment guidelines to avoid long-term management with steroids.2,3 Methods: A retrospective cohort analysis using the Commercial and Medicare Truven Health MarketScan® Databases was conducted 7/1/2013-6/30/2014. The inclusion criteria were age ‡18 years and continuous enrollment during study period. The level of IBD detection [Numerator: Adult IBD patients with an inpatient or outpatient visit; Denominator: All patients meeting inclusion criteria] was calculated to describe the prevalence of IBD within the database. Quality of care metrics calculated include 1) % of IBD patients seen/treated by gastroenterologists [Numerator: IBD patients with a gastroenterologist visit on or after the first IBD diagnosis date during the study period; Denominator: All IBD patients] and 2) % of IBD patients who were not prescribed steroid-sparing therapy (SST) (eg, immunomodulators or biologics) despite being prescribed long-term steroid therapy (LST) ( ‡10mg/day for ‡60 consecutive days or 1 prescription of ‡600mg of steroids) [Numerator: IBD patients prescribed LST but not SST; Denominator: IBD patients prescribed LST]. Results: Within the database, 0.60% (118,500/19,728,701) of patients had IBD diagnoses. States with highest IBD detection were Rhode Island (0.88%), Connecticut (0.84%), and New York (0.80%). States with lowest detection were New Mexico (0.35%), Hawaii (0.41%), and Mississippi (0.43%). Nationally, 66.25% (78,501/118,500) of IBD patients had visited a gastroenterologist on or after the date of IBD diagnosis. States with highest % of patients with gastroenterologist visits were Delaware (79.15%), Washington, DC (76.19%), and Georgia (75.79%). States with lowest % were Mississippi (36.06%), Wyoming (45.16%), and Hawaii (45.45%). Of IBD patients who were managed on long-term steroids in this study, 51.32% (9,211/17,948) were not prescribed an SST. States with highest LST without SST were Wyoming (64.29%), Oklahoma (64.19%), and Montana (62.50%). Lowest rates were South Dakota (33.33%), Nebraska (35.14%), and New Mexico (41.18%). Conclusion: This study provides evidence that there is variability across states in the quality of IBD care and that IBD patients are currently often managed with long-term steroid therapy. These findings indicate that there is a need to better align treatment patterns to IBD treatment guidelines. References: 1. Committee on Quality of Health Care in America. Crossing the quality chasm. National Academies Press; 2001 2. Lichtenstein GR, et al. Am J Gastroenterol. 2009;104:465-83 3. Kornbluth A, Sachar DB. Am J Gastroenterol. 2010;105:501-23
Mo1867 Emergency Department Healthcare Utilization among IBD Patients at an Academic Tertiary Care IBD Referral Center Michelle Vu, Jennifer Phan, Christina Ha Background: Although trends in emergency department (ED) visits by IBD patients have been evaluated, there is a paucity of data regarding resource utilization for IBD management in the ED. We aim to identify features of Crohn's disease (CD) patients presenting to the ED and to assess for potential contributors to the high cost of IBD care in the ED. Methods: We performed a retrospective cohort study of patients with a confirmed diagnosis of CD presenting to the ED of a tertiary care IBD referral center between 3/2013 and 7/2014. Variables of interest included presenting symptoms, ED diagnostic evaluation and therapeutics, predictors of admission and post-ED visit follow-up. Results: 103 CD patients presented to the ER 175 times during the 17-month study period. 57% of patients were female, mean age was 45.6 + 18.5 years old. The most common presenting complaint was abdominal pain (n=114, 65%), followed by nausea/vomiting (13.7%), fever (8.6%), GI bleeding (8%) and diarrhea (8%). Patients who presented with abdominal pain were more likely to have a CT scan in the ED compared to patients who presented with non-pain related complaints (50.4% vs. 33.9%, p=0.04), and they also were more likely to receive narcotics in the ED (73.5% vs. 33.9%, p<0.0001). Abdominal pain on presentation was not a predictor of subsequent steroid administration in the ER, and was a negative risk factor for inpatient admission compared to those non-pain related complaints (55.8% vs. 83.9%, p=0.04). Regardless of the presenting symptom, gastroenterology (GI) follow-up after ED presentation was low (40%) for the CD patients, and a GI consult was only called for 21% of the visits. Patients who were a part of an IBD program were more likely to have post-ER follow up compared to those who were not part of an IBD program (57.1% vs. 30.3%, p=0.007). 36 CD patients had multiple ER visits during this study period, accounting for 107 of 175 of total ER visits (61.6%). This sub-group had multiple CT scans performed (n=11, 30.6%), multiple narcotic prescriptions (n=22, 61.1%), and multiple hospital admissions (n=22, 61.1%). Only 14 (38.9%) had an established GI physician and 16 (44.4%) had an outpatient GI follow up post-ED visit. Patients without an IBD physician accounted for 71.1% of the multiple ER visits. Conclusion: CD patients presenting with abdominal pain to the ED were more likely to have CT scans, narcotics, and frequent encounters, but were not more likely to require admission. There was a low rate of post-ED follow-up for CD patients, which may be contributing to increased ED and healthcare utilization. The majority of ED encounters were from a subgroup of patients without an established IBD physician. Our findings
Mo1865 Patient Reported Outcomes in a managed care Project With Inflammatory Bowel Disease Patients in Germany: CEDnetz-Study Bernd Bokemeyer, Jana Langbrandtner, Petra Jessen, Jürgen Büning, Stefan Schreiber, Heiner Raspe, Angelika Hueppe Background: IBD-patients experience various somatic and psychosocial impairments. They need a comprehensive, interdisciplinary and problem-oriented health care. To improve their quality of health care IBD-pathways recommend a systematic assessment of health-related problems and focus on a multidisciplinary, patient-centered care. In a prospective controlled cohort study German gastroenterologists tried to optimize their quality of care by network activities. The impact on patient reported outcomes was evaluated. Methods: In a region of North Germany 15 gastroenterologists recruited outpatients with IBD (IG: intervention group), outside this region 18 gastroenterologists included nationwide IBD-patients in a control group (CG). At baseline (t0), 6 (t1) and 12 months (t2) patients completed a questionnaire assessing 22 somatic and psychosocial problems. IG-patients received written feedback of their problem-profile together with individualized recommendations for appropriate treatment. Further IG-interventions were the implementation of interdisciplinary IBDcase conferences and the offer of a group-based patient education program. Main outcomes were health related quality of life (HRQoL: EQ-VAS, score: 0-100) and social participation restrictions (IMET, score: 0-10); self-management skills (heiQ) were among the secondary outcomes. Results: 282 of 349 IBD-patients (80.8%; IG: 142 of 189; CG: 140 of 160) participated in both follow-up visits. Baseline characteristics were broadly similar (age: 43 years; 61% female; 50% with Crohn's Disease; 66% in remission; 68% in full- or part time employment). Covariance analyses were used to adjust for baseline differences. No significant differences between IG and CG were seen at follow-up with respect to the primary outcomes,
S-799
AGA Abstracts
AGA Abstracts
the entire group showed small improvements from t0 to t2 (EQ-VAS: 72.5 to 76.2; IMET: 2.1 to 1.9). After 12-months only the IG reported increased self-management skills (heiQ), the CG remained nearly unchanged. In the IG "Self monitoring and Insight" and "Constructive Attitudes and Approaches" as subscales of heiQ showed a significant improvement (p=0.004 and p=0.010), and "Emotional well-being" a tendencial improvement. Conclusion: Our complex intervention could not be proved as effective in the primary outcomes. Nevertheless in the secondary outcomes (self-management skills-heiQ) we found an advantage for the IC. The missing differences between IG and CG could be partially explained by the fact, that not all network activities in the IG could have been realised in the aimed frequency. Further (sub group) analysis will promote the discussion.