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Personalized Inflammatory Bowel Disease Care Reduced Hospitalizations

  • Julia J. LiuEmail author
  • Thomas Brent Rosson
  • Jesse J. Xie
  • Zachary P. Harris
  • Regina G. McBride
  • Eric Siegel
  • Curt Hagedorn
Original Article

Abstract

Background and Aims

IBD patients with inadequately treated disease often relapse and require hospitalizations for further management. The purpose of this practice review was to determine whether personalized IBD care improved patient outcomes as measured by IBD-related hospitalizations.

Methods

A dedicated IBD clinic was created for personalized patient care in a tertiary veterans health care center in 2014. In the first year, the care program consisted of patient-centered medical home (PCMH). In the second year, personalized biologic therapy was incorporated into the program, based on the severity of mucosal barrier dysfunction measured by probe-based confocal laser endomicroscopy (pCLE) analysis of the terminal ileum during colonoscopy. IBD-related hospitalizations during these 2 years were compared to the year before the care program.

Results

The IBD-related admissions at baseline, year 1 and 2 of the program were: total number of admissions of 25, 24, 8 (P = 0.03) per year, total number of hospital days of 177, 144, 31 days per year (P < 0.01), median length of stay 7, 4, and 2 days per visit (P = 0.013), respectively. Patients had significant increases in serum hemoglobin (11.5 ± 2.7, 11.9 ± 2.6, 14.0 ± 1.4 g/dl; P = 0.035), albumin (2.7 ± 0.7, 3.0 ± 0.6 g/dl 3.7 ± 0.8 g/dl; P = 0.031) and body mass index (26.6 ± 2.9, 28.1 ± 5.9; 34.0 ± 10.8; P = 0.047).

Conclusions

Personalized IBD care incorporating a PCMH model and tailored biologic therapy based on pCLE findings of mucosal barrier dysfunction significantly reduced IBD-related hospitalizations.

Keywords

Inflammatory bowel disease Medical home Personalized medicine Hospitalization Confocal laser endomicroscopy 

Abbreviations

BMI

Body mass index

CAVHS

Central Arkansas Veterans Healthcare Systems

IBD

Inflammatory bowel disease

IRB

Institutional Review Board

pCLE

Probe-based confocal laser endomicroscopy

PCMH

Patient-centered medical home

QA

Quality assurance

VA

US Department of Veterans Affairs

Notes

Acknowledgments

The authors would like to thank Peggy Brenner, PhD, ELS (Science Communication Group, University of Arkansas for Medical Sciences) for her editorial assistance.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest that are relevant to this manuscript

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of MedicineCentral Arkansas Veterans Healthcare SystemLittle RockUSA
  2. 2.Division of GastroenterologyUniversity of Arkansas for Medical SciencesLittle RockUSA
  3. 3.Department of NursingCentral Arkansas Veterans Healthcare SystemsLittle RockUSA
  4. 4.Department of BiostatisticsUniversity of Arkansas for Medical SciencesLittle RockUSA

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