A Care Coordination Intervention Improves Symptoms But Not Charges in High-Risk Patients With Inflammatory Bowel Disease

BACKGROUND & AIMSAcute severe ulcerative colitis (ASUC) is a life-threatening presentation of ulcerative colitis requiring prompt treatment. Infliximab (IFX) rescue therapy can prevent colectomy in patients with ASUC.METHODSWe performed a cohort study of adult patients hospitalized with ASUC between 01/2014 – 02/2021 who received infliximab rescue therapy. Using multivariable logistic regression, baseline and longitudinal laboratory predictors of colectomy within 90 days of index hospitalization were identified and used to develop a risk prediction model and prognostic scoring system to identifying patients at risk for colectomy. Model performance was assessed using area under the receiver operator characteristic curve (AUC) analysis.RESULTS166 patients with ASUC who received infliximab rescue therapy were identified. Overall, 24.7% (n=41) underwent colectomy within 90 days. Multivariate analysis revealed that colectomy within 90 days could be predicted by having a calculated IFX clearance of >53L/d (OR 2.28, 95% CI 0.99, 5.22), a day 0 absolute C-reactive protein (CRP) > 91mg/L (OR 3.49, 95% CI 1.58 to 8.08), a decrease in CRP of < 43% from day 0 to day 3 (OR 4.13, 95% CI 1.84 to 9.94), and a decrease in CRP of < 9% from the day of IFX administration to one day post-IFX administration (OR 4.20, 95% CI 1.74 to 10.4). Using these predictors, two highly accurate prognostic scoring system were developed to identify patients at risk for requiring colectomy both prior to administering infliximab (AUC 0.76) and after administer infliximab rescue therapy (AUC 0.81).CONCLUSIONWe identified important baseline and longitudinal laboratory predictors of colectomy within 90-days among patients with ASUC receiving infliximab rescue therapy and developed accurate prognostic scores to determine risk of colectomy. These scores can be used risk-stratify patients and facilitate personalized management.

show abstract

“…Better incorporation of patient reported outcomes throughout inpatient stays could be valuable for future studies in this area. 34…”

Section: Discussionmentioning

confidence: 99%

Predictors of 90-Day Colectomy in Hospitalized Patients Receiving Infliximab for Acute Severe Ulcerative Colitis at a Tertiary Care Center

Berinstein

Atkuri

Berinstein

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…A centralized group to manage communications between these three stakeholders would alleviate the burden for patients and potentially make H-BI more appealing. 10 Additionally, perceived nursing competency was an identified barrier. As such, attention should be given to ensure nursing comfort administering biologic medications, particularly if third party nursing agencies are to be utilized.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory bowel disease patient concerns and experiences on transition to home-based infusions during the COVID-19 pandemic

Jacob¹,

Aintabi²,

DeJonckheere³

et al. 2022

Research in Social and Administrative Pharmacy

Self Cite

View full text Add to dashboard Cite

“…229 The CAPTURE IBD trial explored a similar model to the medical home by incorporating proactive symptoms monitoring with a care coordinator triggered algorithms to create a patient-tailored multicomponent care coordination intervention. 230 This trial randomized IBD patients at a single center to a care coordination intervention or usual care. Patients in the care coordination intervention underwent monthly symptom assessment via an assigned care coordinator and then based on the results would trigger tailored algorithms according to the specific symptom domain of concern.…”

Section: Jak Inhibitorsmentioning

confidence: 99%

Personalized Treatment for Crohn’s Disease: Current Approaches and Future Directions

Clinton,

Cross

2023

CEG

View full text Add to dashboard Cite

Crohn’s disease is a complex, relapsing and remitting inflammatory disorder of the gastrointestinal tract with a variable disease course. While the treatment options for Crohn’s disease have dramatically increased over the past two decades, predicting individual patient response to treatment remains a challenge. As a result, patients often cycle through multiple different therapies before finding an effective treatment which can lead to disease complications, increased costs, and decreased quality of life. Recently, there has been increased emphasis on personalized medicine in Crohn’s disease to identify individual patients who require early advanced therapy to prevent complications of their disease. In this review, we summarize our current approach to management of Crohn’s disease by identifying risk factors for severe or disabling disease and tailoring individual treatments to patient-specific goals. Lastly, we outline our knowledge gaps in implementing personalized Crohn’s disease treatment and describe the future directions in precision medicine.

show abstract

A Care Coordination Intervention Improves Symptoms But Not Charges in High-Risk Patients With Inflammatory Bowel Disease

Cited by 10 publications

References 13 publications

Predictors of 90-Day Colectomy in Hospitalized Patients Receiving Infliximab for Acute Severe Ulcerative Colitis at a Tertiary Care Center

Predictors of 90-Day Colectomy in Hospitalized Patients Receiving Infliximab for Acute Severe Ulcerative Colitis at a Tertiary Care Center

Inflammatory bowel disease patient concerns and experiences on transition to home-based infusions during the COVID-19 pandemic

Personalized Treatment for Crohn’s Disease: Current Approaches and Future Directions

Contact Info

Product

Resources

About