P042  The CONCERT Initiative: Impact of Inflammatory Bowel Disease Care Referral Pathway

P042  The CONCERT Initiative: Impact of Inflammatory Bowel Disease Care Referral Pathway

 

Chapman Casey1, Griffith Jenny2, Bruno Michelle3, Lynch Joe3, McClain Jasmaine3, Theigs Cindy2, Fifer Sheila3
1 Texas Digestive Disease Consultants, Baton Rouge, United States, 2 Abbvie Inc, Mettawa, United States, 3 Avalere Health, Washington, DC United States, Washington, United States

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic disorder that causes substantial economic burden. Patients with IBD can experience depression, anxiety, and malnutrition and may require coordinated care from multiple specialists. The IBD Care Referral Pathway (Pathway) was developed by the American Gastroenterological Association to improve care coordination among healthcare providers (HCP). The CONCERT Initiative assessed adoption and impact of the Pathway in a real-world setting. This analysis described Checklist adoption and referral patterns and evaluated healthcare utilization patterns pre- and post-Pathway implementation.
 
METHODS: The study was conducted at 5 facilities in Baton Rouge and included adults with IBD with ≥1 encounter during a 6-month intervention period and a corresponding encounter pre-intervention for the claims analyses. Pathway intervention included education materials, in-person tutorial, and Pathway Checklist (Checklist). Checklists were available for each encounter during intervention to summarize the patient’s condition and needs for referral. Claims data were extracted from Symphony Health database.

RESULTS: Participating HCPs used the Checklist with 36% of unique patients (665/1830) during 6-month intervention. Utilization was higher at sites that embedded the Checklist into their electronic medical record (EMR). Specialist referral rates were low due to GI services suggested by the Pathway being provided during office visit and poor access to specialists. Claims analyses included 1659 patients (60% female, 49% white, median age 54 years). GI specialist visits increased significantly by 18.5% (54.9% [911/1659] pre-intervention to 73.4% [1217/1659] during intervention; P<0.0001). In this study, average number of emergency department (ED) visits per-person decreased from 2.5 pre-intervention to 2 during intervention. Proportion of patients with IBD-related ED visit pre-intervention versus during intervention was not significant. ED utilization pre-intervention versus during intervention decreased in patients receiving biologics (10.6% [33/311] versus 7.1% [22/311]) and aminosalicylates (12.5% [6/48] versus 6.3% [3/48]) and increased slightly for patients receiving immunomodulators (6.6% [24/361] versus 6.9% [25/361]). IBD-related hospitalizations increased significantly (2.2% [37/1659] pre-intervention versus 3.3% [54/1659] during intervention; P=0.0215). The proportion of patients with ≥1 ambulatory clinic visit decreased significantly (94.2% [1562/1659] pre-intervention versus 92.9% [1541/1659] during intervention; P=0.007). Corticosteroid overuse before and during intervention remained stable in patients receiving biologics (10.0% [31/311] and 9.6% [30/311]), decreased in patients receiving immunomodulators (13.3% [48/361] versus 11.4% [41/361]), and increased in patients receiving aminosalicylates (12.5% [6/48] versus 16.7% [8/48]). Overall GI surgery rates pre- and post-intervention were similar (16% for both).

CONCLUSION(S): Effectively managed IBD patients were expected to have lower unplanned healthcare resource utilization; therefore, IBD-related ED visits and hospitalization may indicate gaps in care identified using Checklist. EMR-embedded forms may result in greater Pathway adoption by HCPs. The short timeframe and limited Checklist use limit interpretation of results. Increase in GI specialist visits during intervention was consistent with Pathway goals. The increase in hospitalization rates may indicate suboptimal IBD management before Pathway implementation and suggests that the benefits of improved management from Pathway implementation require more consistent use of Checklist and >6-months observation period. A follow-up period >6 months is necessary to assess the full impact of Pathway implementation on patient outcomes.