Introduction
Eight hospitals in the southwest of the Netherlands collaborate to provide high quality, uniform care for inflammatory bowel disease (IBD). To achieve this, a care pathway (CP) was implemented for treating IBD with biologics and small molecules (1). The CP is a decision-support tool that provides guidelines for medication prescribing, procedures, treatment adjustments, and recommendations for follow-up.
Aims & Methods
This study aimed to evaluate the effect of a CP on patient outcomes and healthcare utilization.
A longitudinal multicentre non-randomised cohort study with a baseline observation period (December 2020 – December 2021) and a follow-up period (March 2022 – March 2023) was conducted, in which adult patients with IBD treated with biologics or small molecules were included. Outcomes were collected according to the International Consortium for Health Outcomes Measurement (ICHOM) standard set from electronic health records or through validated questionnaires. Missing data were handled using single imputation nested within a bootstrap procedure. Effect of the CP on these outcomes were analysed with case-mix adjusted (generalized) linear mixed models.
Results
A total of 1,173 patients participated in the study, with the majority being female (55%) and a median age of 45 years (IQR 33-58). Most patients had Crohn's disease (64%). The CP was associated with a 0.22 increase on the ibd-control-8 score (β=0.22, p=0.28), and an increase on the probability of achieving endoscopic/radiologic (β=0.14, p=0.29), biochemical (β=0.18, p=0.22) and patient-reported remission (β=0.19, p=0.21). Probability of clinician-reported remission decreased slightly (β=-0.09, p=0.59). Emergency room visits (β=-0.36, p=0.13), hospital admissions (β=-0.41, p=0.10), and length of stay (β=-0.09, p=0.56) reduced, although these associations were not significant. The CP had no effect on quality of life (β=0.00, p=0.83), anaemia probability (β=-0.01, p=0.95) or on nutritional status (β=-0.01, p=0.34).
Conclusion
A CP for the management of IBD with biologicals and small molecules has clinically significant potential to reduce healthcare utilization, while improving patient-reported disease control, and disease remission. These results emphasize that clinical care pathways can improve care and reduce healthcare utilisation for complex diseases. However, the adherence to the CP and whether these results lead to a reduction in healthcare costs should be further investigated.
References
(1) van Linschoten R, van Leeuwen N, Nieboer D, Birnie E, Scherpenzeel M, Verweij KE, et al. Value-based care pathway for inflammatory bowel disease: a protocol for the multicentre longitudinal non-randomised parallel cluster IBD Value study with baseline period. (2044-6055 (Electronic))
Disclosure
Drs. Visser received a speaker fee from Lilly, Prof. Dr. van der Woude reports grants from Pfizer and Janssen and personal fees from AbbVie and Celltrion, Dr. van Noord reports personal fees from Janssen, Takeda, and Falk, Dr. West reports personal fees from AbbVie, Janssen, and Pfizer outside the submitted work.