Background: Integrated models of care (IMC) for inflammatory bowel disease (IBD) have been implemented to improve the quality of care and disease management, and reduce adverse outcomes. Studies providing a systematic assessment of the impact of IMC for IBD on health care utilization have not previously been undertaken. This study compared health care services and medication use for IBD patients who were and were not exposed to an IMC.
Methods: A retrospective population-based cohort study was conducted between 2009 and 2015 using administrative health data for the province of Saskatchewan (SK), Canada. The SK IMC for IBD (the Multidisciplinary IBD Clinic—MDIBDC) was introduced in 2009. Patients with IBD were identified with a validated administrative case definition applied to hospital and physician billing records. The criteria for measuring exposure to the IMC included baseline and follow-up visits with MDIBDC physicians. Cox proportional hazard regression models with propensity-score matching were used to test for differences in IBD-related hospitalizations, surgeries, and medications use (5-aminosalicylic acid—5-ASA, immune modulator—IM, and biologics) between patients with and without MDIBDC exposure. Adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated. Conditional logistic regression was used to test for differences in the probability of corticosteroid dependency (CsD) over a 6-month period.
Results: The study included 2312 IBD patients. In the sample, the mean age was 44.1 (SD=15.8) years, 51.5% were women, 74.7% had urban residence, 39.6% had ulcerative colitis (UC), and 24.3% were defined as exposed. The exposed group had a lower rate of IBD-related surgeries (HR=0.72, 95% CI 0.57–0.91), higher rate of IM (HR=1.75, 95% CI 1.48–2.05), higher biologic use (HR=1.75, 95% CI 1.48–2.05), and lower 5-ASA use (HR=0.79, 95% CI 0.68–0.92) than the non-exposed group. Analyses stratified by disease type revealed a lower rate of IBD-related hospitalization in exposed UC patients (HR=0.71, 95% CI 0.53–0.94). The odds of CsD amongst patients with UC in the exposed group was 0.39 (95% CI 0.15–0.98) that of the non-exposed group. No significant differences in CsD were identified in the full group analysis.
Conclusions: Differences in adverse disease outcomes between exposed and non-exposed patients reflect the improved quality of care provided within an IMC for IBD. Increased use of steroid-sparing maintenance therapies, specifically IM and biologics, is an indicator of improved access to IBD therapies, as is the lower CsD use amongst patients with UC. Integrated models can positively impact the health care outcomes of patients with IBD, and, subsequently, lead to effective use of health care resources.