Natalie E. Duran

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% (

Value redefined for inflammatory bowel disease patients: a choice-based conjoint analysis of patients’ preferences

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.

Tu1075 The Impact of a Value-Based Health Program for Inflammatory Bowel Disease Management on Healthcare Utilization

Purpose Value-based healthcare is an upcoming field. The core idea is to evaluate care based on achieved outcomes divided by the costs. Unfortunately, the optimal way to evaluate outcomes is ill-defined. In this study, we aim to develop a single, preference based, outcome metric, which can be used to quantify overall health value in inflammatory bowel disease (IBD).MethodsIBD patients filled out a choice-based conjoint (CBC) questionnaire in which patients chose preferable outcome scenarios with different levels of disease control (DC), quality of life (QoL), and productivity (Pr). A CBC analysis was performed to estimate the relative value of DC, QoL, and Pr. A patient-centered composite score was developed which was weighted based on the stated preferences.ResultsWe included 210 IBD patients. Large differences in stated preferences were observed. Increases from low to intermediate outcome levels were valued more than increases from intermediate to high outcome levels. Overall, QoL was more important to patients than DC or Pr. Individual outcome scores were calculated based on the stated preferences. This score was significantly different from a score not weighted based on patient preferences in patients with active disease.ConclusionsWe showed the feasibility of creating a single outcome metric in IBD which incorporates patients’ values using a CBC. Because this metric changes significantly when weighted according to patients’ values, we propose that success in healthcare should be measured accordingly.

How are Patient Outcomes Impacted by Value Based Health Care Delivery for Inflammatory Bowel Diseases

is cardiovascular disease for which antiplatelets and anticoagulants are prescribed. Thus, baby boomers are at risk of gastrointestinal bleeding (GIB) related to both pharmacologic exposure and advancing age. In 2012, the cost of GIB care was estimated at >

Do We Properly Diagnose Our Celiac Patients? Three Year Follow up in a Celiac Referral Center

2.5 billion; half of which was billed to Medicare. Quantifying health care utilization of current baby boomers with GI bleeding will assist policy makers to forecast impact of this generation on future health care resource needs. Methods: A retrospective cohort study using 5 years of the Nationwide Inpatient Sample (2007-2011) was conducted to identify temporal trends in non-variceal, upperand lower-GIB to assess impact of age, co-morbidity, early vs. late endoscopy, transfer status, and disposition on the outcomes of hospital length of stay, 30day mortality and economic outcomes (charge). Temporal trends were evaluated using the Cochrane-Armitage test. The Chi-square test and multivariable linear regression models were used to quantify the impact of exposures of interest and potential effect modifiers on hospital length of stay and charge. Results: From 2007 to 2011 there were 1,322,122 hospital visits associated with GIB in 18,259,654 patients >50 years. Three-quarters of admissions were emergent, 19% occurred on the weekend and 51% were lower GIB. Overall prevalence was 7.2%, with an average length of stay (LOS) of 5.5 days (SD: 6.1) in 2007 that decreased to 5.1 days (SD: 5.7) by 2011 (p<0.001). A 1.4 day (95% CI: 1.31-1.44) increase in LOS was observed among patients ≥70 with a Charlson co-morbidity score ≥2. In-hospital mortality decreased over time from 2.5% to 2.0% (p<0.001). Total hospital charge increased over time from

308 The Impact of a Value-Based Health Care in Inflammatory Bowel Diseases on Health Care Utilization

29,602 (2007) to

801 Quantification of Patients' Preferences for Outcome Metrics in Inflammatory Bowel Diseases Using a Choice Based Conjoint Analysis

38,549 (2011), p<0.001. Medicare or Medicaid was the primary payer in 39%. Primary drivers of the attributable charge (per admission) included age ≥70 years with a Charlson co-morbidity score ≥2 (

311a Assessment of Differences Between Academic and Non-Academic Providers in Inflammatory Bowel Diseases Related Utilization Using a Large Administrative Dataset

6,068; 95% CI:

Tu1230 Integrated Care Pathways for Inflammatory Bowel Disease Surgery: Design and First Analysis

5,796-

Tu1231 Time-Driven Activity Based Costing: Measuring the Costs of Implementing Quality Measures in Inflammatory Bowel Disease (IBD)

6,339); a transfer from another acute care facility (