Bridging Healthcare Disparities in Patients With Inflammatory Bowel Disease (IBD) in Underserved Communities: Results From a Telemedicine Intervention at a Large Tertiary Care Center

Background: The prevalence of IBD in the United States is greater than 3 million and rising, while the access to IBD specialists in rural areas remains limited. Urban areas associated with large healthcare systems have 263 specialists per 100,000 residents, whereas rural areas have only 30 specialists per residents. The specific aims of this study are to identify the impact access to specialty care has on frequency of IBD flares, emergency department (ED) visits, and hospitalizations. Methods: We conducted a retrospective chart review of adult patients (>18 years) with the diagnosis of IBD who reside in Michigan. Patients were divided into either pre or post periods, where pre-period was defined as before the initiation of telehealth services between 1/1/2018-12/31/2019, and post-period was defined as after the advent of telehealth, between 10/1/2021-10/31/2022, including both video visits as well as the Henry Ford Specialty Center, which offers IBD specialty care virtually. Patient’s demographic information, IBD encounters, ED visits, hospitalizations were collected at the end of each study period. The outcomes of interest were the number of IBD-related outpatient encounters, ED visits, and hospitalizations in each period. Results: A total of 5520 IBD encounters were observed in both time periods from 4941 individual patients. Among the total 4941patients, 2992 patients were in the pre-period cohort, and 1949 patients were in the post-period cohort including 721 patients who were seen in both period cohorts. Patients’ IBD encounters were significantly reduced in the post-period compared to those in the pre-period (RR=0.73, 95% CI 0.69-0.76 and p-value< 0.001). There was also a significant decrease in ED visits (RR=0.53, 95% CI 0.50-0.56) and hospitalizations in the post-period (RR=0.35, 95% CI 0.33-0.37). In addition, we looked at the geospatial distribution in patients and found that there was a wider distribution of patients seeking care for their IBD in neighboring and rural counties in the post-period compared to the pre-period. Conclusions: The IBD Center at Henry Ford Health serves more than 3,000 patients annually and an estimated 15% travel more than 60 miles for their care. Given the need to provide specialty care throughout Michigan, Henry Ford Health is offering telehealth services within a standard clinic to overcome the barriers of telehealth in IBD care. Our study shows that this effort has bridged access to medical care and increased distribution of patients in Michigan receiving specialty care for IBD. It also significantly reduced IBD flares, hospitalization, and ED visits for these patients.