Specialty Medical Homes to Improve Outcomes for Patients with Inflammatory Bowel Disease and Behavioral Health Conditions

Background

IBD is an umbrella term for Crohn’s disease and ulcerative colitis. Approximately 1.3% of U.S. adults live with IBD, and average hospitalization costs can range from $11k to $13k per patient. See our clinicaltrials.gov and PCORI® project descriptions for more details.

Healthcare Challenge

Patients with IBD often have coexisting behavioral health conditions, including depression or anxiety, which can exacerbate physical health symptoms and negatively impact quality of life. Additionally, there is a shortage of health care specialists to treat this complex, chronic condition that often requires care from multiple clinicians. Specialty medical homes (SMH), which are locations in which patients receive team-based care from clinicians within a single office, may help to overcome these challenges. However, questions remain around how to organize and deliver care most effectively and sustainably.

Goals

• Provide useful information to health systems and providers on available options for supporting individuals with IBD to make patient-centered health care choices.
• Develop a “how-to” toolkit to support implementation and dissemination of the IBD SMH and scale to other types of providers, health systems, and chronically ill populations.

Implementation Approach

Population

Patients aged 18-60 years diagnosed with both inflammatory bowel disease and anxiety and/or depression.

Methodology

This randomized controlled trial compared the impact of two team-based methods for integrating physical and behavioral health services for people with IBD and anxiety/depression.

• TEAM: Patients received care in an intensive high-human touch multidisciplinary clinical team model, which may have included regular appointments with gastroenterologists, nurse practitioners, psychologists, psychiatrists, dietitians, social workers, and pharmacists. The number of visits varied based on the severity of patient IBD and behavioral health symptoms and occurred either in person, over the phone, or via telehealth/video.

• TECH: Patients had access to the multidisciplinary team members mentioned above, though they met for formal appointments with their behavioral health providers less often and were given access to a digital cognitive behavioral therapy mobile application (app) designed to help develop skills to manage symptoms of anxiety and/or depression. Embedded health care coaches helped direct and monitor their progress and relayed any concerns or improvements to the clinical team.

Participants completed surveys at the time of enrollment and at 6 and 12-month timepoints to report on changes in physical and behavioral health disease severity, functional impairment, healthcare use, quality of life, and patient disease self-management.

Both participants and clinical staff completed qualitative interviews to share feedback on challenges and benefits to engaging and/or implementing the TEAM and TECH approaches.

The study design, implementation, and results interpretation were advised by site working groups made up of clinicians, patients, and researchers, a patient co-investigator with clinical and health systems experience, and an advisory board of health providers, caregivers, patients, researchers, payers, policy makers, and community organizations.

To learn more, contact us at IBDStudy@upmc.edu.

This project was funded through the Patient-Centered Outcomes Research Institute® (PCORI®) Award IHS-2017C3-8930. The views, statements, and opinions presented in this webpage are solely the responsibility of the author(s) and do not necessarily represent the views of PCORI®.