The impact of value-based healthcare for inflammatory bowel diseases on healthcare utilization: a pilot study.

BACKGROUND AND OBJECTIVES: Value-based healthcare (VBHC) is considered to be the solution that will improve quality and decrease costs in healthcare. Many hospitals are implementing programs on the basis of this strategy, but rigorous scientific reports are still lacking. In this pilot study, we present the first-year outcomes of a VBHC program for inflammatory bowel disease (IBD) management that focuses on highly coordinated care, task differentiation of providers, and continuous home monitoring. METHODS: IBD patients treated within the VBHC program were identified in an administrative claims database from a commercial insurer allowing comparisons to matched controls. Only patients for whom data were available the year before and after starting the program were included. Healthcare utilization including visits, hospitalizations, laboratory and imaging tests, and medications were compared between groups. RESULTS: In total, 60 IBD patients treated at the VBHC Center were identified and were matched to 177 controls. Significantly fewer upper endoscopies were performed (-10%, P=0.012), and numerically fewer surgeries (-25%, P=0.49), hospitalizations (-28%, 0=0.71), emergency department visits (-37%, P=0.44), and imaging studies (-25 to -86%) were observed. In addition, 65% fewer patients (P=0.16) used steroids long term. IBD-related costs were 16% ($771) lower than expected (P=0.24). CONCLUSION: These are the first results of a successfully implemented VBHC program for IBD. Encouraging trends toward fewer emergency department visits, hospitalizations, and long-term corticosteroid use were observed. These results will need to be confirmed in a larger sample with more follow-up.

Presenteeism in Inflammatory Bowel Diseases: A Hidden Problem with Significant Economic Impact.

BACKGROUND: Indirect costs associated with impaired productivity at work (presenteeism) due to inflammatory bowel disease (IBD) are a major contributor to health expenditures. Studies estimating indirect costs in the United States did not take presenteeism into account. We aimed to quantify work limitations and presenteeism and its associated costs in an IBD population to generate recommendations to reduce presenteeism and decrease indirect costs. METHODS: We performed a prospective study at a tertiary IBD center. During clinic visits, work productivity, work-related problems and adjustments, quality of life, and disease activity were assessed in patients with IBD. Work productivity and impairment were assessed in a control population as well. Indirect costs associated with lost work hours (absenteeism) and presenteeism were estimated, as well as the effect of disease activity on those costs. RESULTS: Of the 440 included patients with IBD, 35.6% were unemployed. Significantly more presenteeism was detected in patients with IBD (62.9%) compared with controls (27.3%) (P = 0.004), with no significant differences in absenteeism. Patients in remission experienced significantly more presenteeism than controls (54.7% versus 27.3%, respectively, P < 0.01), and indirect costs were significantly higher for remissive patients versus controls ($17,766 per yr versus $9179 per yr, respectively, P < 0.03). Only 34.3% had made adjustments to battle work-related problems such as fatigue, irritability, and decreased motivation. CONCLUSIONS: Patients with IBD in clinical remission still cope with significantly more presenteeism and work limitations than controls; this translates in higher indirect costs and decreased quality of life. The majority have not made any adjustments to battle these problems.

A nationwide 2010-2012 analysis of U.S. health care utilization in inflammatory bowel diseases.

BACKGROUND: Implementation of the 2010 Affordable Care Act (ACA) calls for a collaborative effort to transform the U.S. health care system toward patient-centered and value-based care. To identify how specialty care can be improved, we mapped current U.S. health care utilization in patients with inflammatory bowel diseases (IBD) using a national insurance claims database. METHODS: We performed a cross-sectional study analyzing U.S. health care utilization in 964,633 patients with IBD between 2010 and 2012 using insurance claims data, including pharmacy and medical claims. Frequency of IBD-related care utilization (medication, tests, and treatments) and their charges were evaluated. Subsequently, outcomes were put into the framework of current U.S. guidelines to identify areas of improvement. RESULTS: A disproportionate usage of aminosalicylates in Crohn's disease (42%), frequent corticosteroid use (46%, with 9% long-term users), and low rates of corticosteroid-sparing drugs (thiopurines 15%; methotrexate 2.7%) were observed. Markers for inflammatory activity, such as C-reactive protein or fecal calprotectin were not commonly used (8.8% and 0.13%, respectively). Although infrequently used (11%), anti-TNF antibody therapy represents a major part of observed IBD charges. CONCLUSIONS: This analysis shows 2010-2012 utilization and medication patterns of IBD health care in the United States and suggests that improvement can be obtained through enhanced guidelines adherence.

Adherencia al tratamiento antirretroviral en una consulta de infectología / Adherence to antiretroviral therapy in a query infectology

Estudiar el grado de adherencia al tratamiento antirretroviral en los pacientes controlados por la consulta de infectología adultos, en la CHET. Se realizó un estudio descriptivo-prospectivo entre junio y agosto de 2004, aplicando una encuesta al 30 por ciento del total de pacientes controlados. Por esa consulta hasta la fecha. 32,56 por ciento femeninos y 67,44 por ciento, masculinos, 65 por ciento de 21-40 años. Con tiempo de tratamiento menor de un año 60 por ciento; 32,56 por ciento con pareja estable y 42 por ciento desempleados, 65 por ciento con estudios entre medios y superiores. 86 por ciento tuvo buena tolerancia al tratamiento desde su inicio. En 15 (34 por ciento) pacientes hubo necesidad de cambiar el tratamiento, 3 por incumplimiento, 3 por disponibilidad y 9 por efectos adversos, 2 abandonaron el tratamiento en alguna oportunidad y 50 por ciento presentó algún signo de depresión. Tres abandonaron el tratamiento en alguna ocasión, de estos 2 con ideas suicidas, 2 desempleados, 2 con intolerancia al tratamiento por efectos adversos, ninguno con pareja estable y no hubo preferencia sexual. El 98 por ciento refirió buena adherencia a su tratamiento, 82 por ciento se tomaban el tratamiento siempre en el mismo horario. Del total de pacientes 18 (42 por ciento) con un segundo control de CD4 y carga viral, evidenciando mejoría en todos los casos, independientemente de su adherencia. Evidenciamos buena adherencia en los pacientes, independientemente de su edad, sexo, grado de intrucción, o preferencia sexual; la tolerancia, la necesidad de cambio y el abandono tuvo relación con el estado emocional, al igual que lo reportado por otros autores. Tampoco hubo diferencias entre los esquemas de tratamiento y adherencia al mismo.