Department of Community Health and Epidemiology, University of Saskatchewan, Canada.
Department of Community Health Sciences, University of Manitoba, Canada.
J Crohns Colitis. 2017 Dec 4;11(12):1471-1479. doi: 10.1093/ecco-jcc/jjx106.
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.
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].
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].
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.
需要评估炎症性肠病（IBD）综合护理模式[IMC]对疾病相关结局的影响的研究。我们比较了暴露于 IMC 和未暴露于 IMC 的患者的 IBD 相关结局和处方药物索赔的风险。
这是一项 2009 年至 2015 年期间进行的回顾性基于人群的匹配队列研究，使用加拿大萨斯喀彻温省的行政健康数据。使用验证的行政定义识别出年龄在 18 岁及以上患有 IBD 的患者。病例分为暴露于 IBD 的 IMC 和未暴露于 IMC，并根据倾向评分和疾病持续时间进行匹配。测量 IBD 相关住院、手术、处方药物索赔和皮质类固醇依赖性[CsDep]。Cox 和逻辑回归模型评估了两组之间的差异，用相应的置信区间[CI]估计危险[HR]和优势[OR]比。
共纳入 2312 例匹配患者；24.3%为暴露个体。与未暴露组相比，暴露组 IBD 相关手术的风险较低[HR=0.78，95%CI 0.61-0.99]，免疫调节剂[HR=1.68，95%CI 1.42-1.99]和生物制剂[HR=1.85，95%CI 1.52-2.27]的处方风险较高，5-氨基水杨酸制剂的处方风险较低[HR=0.81，95%CI 0.69-0.95]。分层分析显示，暴露于溃疡性结肠炎[UC]的患者的 IBD 相关住院风险较低[HR=0.66，95%CI 0.49-0.89]。暴露于 UC 的患者 CsDep 的几率为 0.39[95%CI 0.15-0.98]。
观察到暴露于 IMC 和未暴露于 IMC 的个体之间疾病相关结局和使用类固醇节约维持治疗的差异支持这样一种概念，即增强 IBD 的护理质量可以在 IMC 中实现。
