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December 7, 2017

Integrated care better for people with inflammatory bowel disease

Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, is a chronic disease of the gastrointestinal tract. People living with IBD receive better medical management and experience fewer disease-related complication when their care is delivered in an integrated, collaborative manner, according to a new study involving researchers from the Health Quality Council and Universities of Saskatchewan, Manitoba, and Dalhousie. This is the first population-based study to explore the impact of an integrated model of care on IBD-related outcomes.

The research, led by Juan-Nicolas Pena-Sanchez from the University of Saskatchewan, compared outcomes for people who received a traditional approach to IBD care, with outcomes among those who received an integrated model of care. This integrated model involves coordinated care, education, prevention, and active follow-up by an interdisciplinary team. The researchers found that patients treated with the integrated approach had fewer IBD-related hospitalizations and surgeries, were less likely to be dependent on steroid medication, and more likely to be on appropriate IBD drugs (specifically biologics and immunomodulators).  

“We identified differences in adverse disease outcomes and medication use that reflect both better care and access to appropriate IBD medications. This evidence suggests integrated care could lead to improved quality of care and more efficient use of health care resources.” (Juan-Nicolas Pena-Sanchez)

Fewer hospitalizations and surgeries represent better quality of care. These “rescue” events are required when treatment through medication alone is not successful. Hospitalizations and surgeries can both lead to poorer health outcomes for patients, as can worsening of the disease itself. Further, long-term use of steroid medication has serious side-effects, including acne, sleep and mood disorders, glucose intolerance, osteoporosis, and susceptibility to infections.

This study is the first in a series looking at how to improve care for people with IBD. Other research underway includes evaluation of

  1.  the cost effectiveness of the integrated model of care in Saskatchewan;
  2. exposure to IBD-medications during pregnancy;
  3. inequities in access to IBD care according to area of residence;
  4. provincial epidemiological trends of IBD;
  5. combined therapies for IBD;
  6. use and failure of biologics; and,
  7. influence of IBD on pregnancy and conception rates.

Several of these projects are conducted in collaboration with the Canadian Gastro-Intestinal Epidemiology Consortium (CanGIEC).

“Ultimately, this study and the others in the queue are all about developing and testing a better standard of care for people with IBD. This research is building the evidence base to inform changes in how we deliver care.” (HQC Chief Executive Officer, and co-investigator)

One of HQC’s strategic priorities is to measure health care outcomes and processes to generate evidence for decision making. Making good data available quickly — on health care processes and results — is essential for providing high-quality care.
Citation: Juan Nicolás Peña-Sánchez, Lisa M Lix, Gary F Teare, Wenbin Li, Sharyle A Fowler, Jennifer L Jones; Impact of an Integrated Model of Care on Outcomes of Patients With Inflammatory Bowel Diseases: Evidence From a Population-Based Study, Journal of Crohn’s and Colitis, jjx106, https://doi.org/10.1093/ecco-jcc/jjx106