Abstract

Integrated inflammatory bowel disease (IBD) care is effective but not routinely implemented. Validated methods that simultaneously address mind and body targets such as resilience may improve access and outcomes. We describe the development and implementation of the GRITT method and its impact on resilience, health care utilization (HCU), and opioid use in IBD. Consecutive patients from an academic IBD center were evaluated for low resilience on the basis of provider referral. Low resilience patients were invited to participate in the GRITT program. Primary outcome was % reduction in HCU. Secondary outcomes were change in resilience and corticosteroid and opioid use. Patients were allocated into 2 groups for analysis: GRITT participants (GP) and non-participants (NP). Clinical data and HCU in the year before enrollment were collected at baseline and 12 months. One-way repeated measures multivariate analysis of covariance evaluated group× time interactions for the primary outcome. Effect size was calculated for changes in resilience over time. Of 456 screened IBD patients 394 were eligible, 184 GP and 210 NP. GP had greater reduction in HCU than NP: 71% reduction in emergency department visits, 94% reduction in unplanned hospitalizations. There was 49% reduction in opioid use and 73% reduction in corticosteroid use in GP. Resilience increased by 27.3 points (59%), yielding a large effect size (d= 2.4). Mind-body care that focuses on building resilience in the context of IBD care may be a novel approach to reduce unplanned HCU and opioid use, but large, multicenter, randomized controlled trials are needed.

Highlights

  • BACKGROUND & AIMSIntegrated inflammatory bowel disease (IBD) care is effective but not routinely implemented

  • Gaining Resilience through Transitions (GRITT) participants (GP) had greater reduction in health care utilization (HCU) than NP: 71% reduction in emergency department visits, 94% reduction in unplanned hospitalizations

  • Mind-body care that focuses on building resilience in the context of IBD care may be a novel approach to reduce unplanned HCU and opioid use, but large, multicenter, randomized controlled trials are needed

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Summary

Methods

Consecutive patients from an academic IBD center were evaluated for low resilience on the basis of provider referral. Low resilience patients were invited to participate in the GRITT program. One-way repeated measures multivariate analysis of covariance evaluated group 3 time interactions for the primary outcome. Consecutive patients seen in an academic IBD center were referred to GRITT by their IBD specialist and evaluated between August 2016 and March 2019. Providers were trained in the identification of low resilient patients and behavioral referral process to increase uptake. Patients determined to have low resilience on the basis of the validated, clinician administered resilience tool were eligible for enrollment in the GRITT IBD program. Eligibility required that the patient was planning to continue receiving care at the IBD Center for the duration of the program.

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