Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Clin Gastroenterol Hepatol. 2018 Nov;16(11):1777-1785. doi: 10.1016/j.cgh.2018.04.007. Epub 2018 Apr 12.
BACKGROUND & AIMS: Specialty medical homes (SMHs) are a new health care model in which a multidisciplinary team and specialists manage patients with chronic diseases. As part of a large integrated payer-provider network, we formed an inflammatory bowel diseases (IBDs) SMH and investigated its effects on health care use, disease activity, and quality of life (QoL).
We performed a retrospective analysis of 322 patients (58% female; mean age, 34.6 y; 62% with Crohn's disease; 32% with prior IBD surgery) enrolled in an IBD SMH, in conjunction with the University of Pittsburgh Medical Center Health Plan, from June 2015 through July 2016. Patients had at least 1 year of follow up. We evaluated changes in numbers of emergency department visits and hospitalizations from the year before vs after SMH enrollment. Secondary measures included IBD activity assessments and QoL.
Compared to the year before IBD SMH enrollment, patients had a 47.3% reduction in emergency department visits (P < .0001) and a 35.9% reduction in hospitalizations (P = .008). In the year following IBD SMH enrollment, patients had significant reductions in the median Harvey-Bradshaw Index score (reduced from 4 to 3.5; P = .002), and median ulcerative colitis activity index score (from 4 to 3; P = .0003), and increases in QoL (median short inflammatory bowel disease questionnaire score increased from 50 to 51.8; P < .0001). Patients in the most extreme (highest and lowest) quartiles had the most improvement when we compared scores at baseline vs after enrollment. Based on multivariable regression analysis, use of corticosteroids (odds ratio [OR], 2.72; 95% CI, 1.32-5.66; P = .007) or opioids (OR, 3.20; 95% CI, 1.32-7.78; P = .01), and low QoL (OR, 4.44; 95% CI, 1.08-18.250; P = .04) at enrollment were significantly associated with persistent emergency department visits and hospitalizations.
We found development of an IBD SMH to be feasible and significantly reduce unplanned care and disease activity and increase patient QoL 1 year after enrollment.
专科医疗之家（SMHs）是一种新的医疗保健模式，其中多学科团队和专家共同管理患有慢性病的患者。作为大型综合支付方-服务提供方网络的一部分，我们组建了炎症性肠病（IBD）SMH，并研究了其对医疗保健使用、疾病活动度和生活质量（QoL）的影响。
我们对 2015 年 6 月至 2016 年 7 月期间，在匹兹堡大学医学中心健康计划（University of Pittsburgh Medical Center Health Plan）参与 IBD SMH 的 322 名患者（58%为女性；平均年龄 34.6 岁；62%为克罗恩病患者；32%有 IBD 手术史）进行了回顾性分析。患者的随访时间至少为 1 年。我们评估了从 SMH 入组前一年到入组后一年急诊就诊次数和住院次数的变化。次要指标包括 IBD 活动评估和 QoL。
与 SMH 入组前一年相比，患者急诊就诊次数减少了 47.3%（P<0.0001），住院次数减少了 35.9%（P=0.008）。在 SMH 入组后的一年中，患者的 Harvey-Bradshaw 指数评分中位数显著降低（从 4 分降至 3.5 分；P=0.002），溃疡性结肠炎活动指数评分中位数显著降低（从 4 分降至 3 分；P=0.0003），QoL 显著升高（短炎症性肠病问卷评分中位数从 50 分增至 51.8 分；P<0.0001）。当我们比较基线与入组后评分时，得分处于最极端（最高和最低）四分位区间的患者改善最明显。基于多变量回归分析，使用皮质类固醇（比值比 [OR]，2.72；95%置信区间 [CI]，1.32-5.66；P=0.007）或阿片类药物（OR，3.20；95%CI，1.32-7.78；P=0.01），以及入组时 QoL 较低（OR，4.44；95%CI，1.08-18.250；P=0.04）与持续急诊就诊和住院显著相关。
我们发现建立 IBD SMH 是可行的，并能显著减少非计划性医疗和疾病活动度，增加患者入组后 1 年的生活质量。
