Inflammatory Bowel Disease Care Research Articles

Variation Between Hospitals in Outcomes and Costs of IBD Care: Results From the IBD Value Study.

Data on variation in outcomes and costs of the treatment of inflammatory bowel disease (IBD) can be used to identify areas for cost and quality improvement. It can also help healthcare providers learn from each other and strive for equity in care. We aimed to assess the variation in outcomes and costs of IBD care between hospitals. We conducted a 12-month cohort study in 8 hospitals in the Netherlands. Patients with IBD who were treated with biologics and new small molecules were included. The percentage of variation in outcomes (following the International Consortium for Health Outcomes Measurement standard set) and costs attributable to the treating hospital wereanalyzed with intraclass correlation coefficients (ICCs) from case mix-adjusted (generalized) linear mixed models. We included 1010 patients (median age 45 years, 55% female). Clinicians reported high remission rates (83%), while patient-reported rates were lower (40%). During the 12-month follow-up, 5.2% of patients used prednisolone for more than 3 months. Hospital costs (outpatient, inpatient, and medication costs) were substantial (median: €8323 per 6 months), mainly attributed to advanced therapies (€6611). Most of the variation in outcomes and costs among patients could not be attributed to the treating hospitals, with ICCs typically between 0% and 2%. Instead, patient-level characteristics, often with ICCs above 50%, accounted for these variations. Variation in outcomes and costs cannot be used to differentiate between hospitals for quality of care. Future quality improvement initiatives should look at differences in structure and process measures of care and implement patient-level interventions to improve quality of IBD care. NL8276.

Inequalities in Healthcare Access, Experience and Outcomes in Adults With Inflammatory Bowel Disease: A Scoping Review.

Inflammatory bowel diseases (IBDs) are incurable diseases that require lifelong access to health services. Accumulating evidence of inequalities in health care access, experience, and outcomes for individuals with IBD is apparent. This review aimed to describe the inequalities in healthcare access, experiences, and outcomes of care for adults with IBD, to identify research gaps, and to identify future research priorities in this area. A scoping review was conducted to retrieve quantitative, qualitative, and mixed methods evidence from 3 databases (EMBASE, Medline, and CINAHL) published between January 1, 2000, and September 27, 2023. Fifty-one studies met the criteria for inclusion. The majority (42 of 51) focused on IBD health outcomes, followed by healthcare access (24 of 51). Significantly fewer investigated patient experiences of IBD healthcare (8 of 51). Most available studies reported on race/ethnic disparities of healthcare (33 of 51), followed by inequalities driven by socioeconomic differences (12 of 51), rurality (7 of 51), gender and sex (3 of 51), age (2 of 51), culture (2 of 51), literacy (1 of 51), and sexuality (1 of 51). Inflammatory bowel disease patients from Black, Asian, and Hispanic ethnic groups had significantly poorer health outcomes. A lack of research was found in the sexual and gender minority community (1 of 51). No research was found to investigate inequalities in IBD patients with learning disabilities or autism. Further research, particularly utilizing qualitative methods, is needed to understand health experiences of underserved patient populations with IBD. Cultural humility in IBD care is required to better serve individuals with IBD of Black and Asian race/ethnicity. The lack of research amongst sexual and gender minority groups with IBD, and with learning disabilities, poses a risk of creating inequalities within inequalities.

Economics of Emergency Department Visits by Patients With Inflammatory Bowel Disease: A Real-World Analysis.

Inflammatory bowel disease (IBD) is associated with significant psychosocial, economic, and physical burden on patients. IBD care in the United States results in significant healthcare expenditure with recurring emergency department (ED) care and hospital admissions. Despite advances in therapy and improved access to specialty care, there is still room for improvement in cost-efficient care. Specialty medical homes and interdisciplinary care models have emerged as ways to improve medical care, patient outcomes, and quality of life, as well as improve the impact of healthcare costs. There is limited real-world data on cost in the United States, with many articles citing cost estimates from models. We analyzed real-world data from our tertiary care center with a focus on recurrent ED visits by IBD patients. Descriptive statistics were used for a cost analysis of multiple ED visits by IBD patients. Patients with ≥4 visits to the ED in a 6-month period were described as SuperUsers and were included in a separate analysis. The cost of hospitalization was also included. Total cost associated with all ED visits from SuperUsers were $72999.57 with an average of $6636.32 per patient. When the patients were admitted, the total cost of ED visits and hospitalizations was $721461.52, with an average of $65587.41 per patient. ED utilization by IBD patients with or without hospitalization is expensive and is typically driven by a cohort of SuperUsers. More work needs to be done to improve cost-effectiveness in IBD care, including reducing the frequency of ED visits.

Remote Between Visit Monitoring in Inflammatory Bowel Disease Care: A Qualitative Study of CAPTURE-IBD Participants and Care Team Members.

We recently showed that CAPTURE-inflammatory bowel disease (IBD)-a care coordination intervention comprised of routine remote monitoring of patient-reported outcomes (PRO) and a care coordinator-triggered care pathway-was more effective at reducing symptom burden for patients with IBD compared to usual care. We aimed to understand how patients and care team providers experienced the intervention and evaluate purported mechanisms of action to plan for future implementation. In this study, 205 patients were randomized to CAPTURE-IBD (n = 100) or usual care(n = 105). We conducted semi-structured interviews with 16 of the 100 participants in the CAPTURE-IBD arm and 5 care team providers to achieve thematic saturation. We used qualitative rapid analysis to generate a broad understanding of experiences, perceived impact, the coordinator role, and suggested improvements. Findings highlight that the intervention was acceptable and user-friendly, despite concerns regarding increased nursing workload. Both participants and care team providers perceived the intervention as valuable in supporting symptom monitoring, psychosocial care, and between-visit action plans to improve IBD care and health outcomes. However, few participants leveraged the care coordinator as intended. Finally, participants reported that the intervention could be better tailored to capture day-to-day symptom changes and to meet the needs of patients with specific comorbid conditions (eg, ostomies). Remote PRO monitoring is acceptable and may be valuable in improving care management, promoting tight control, and supporting whole health in IBD. Future efforts should focus on testing and implementing refined versions of CAPTURE-IBD tailored to different clinical settings.

Letting go of control: A qualitative descriptive study exploring parents' perspectives on their child's transition from pediatric to adult care for inflammatory bowel disease.

Parents of young adults with chronic disease are important stakeholders in their child's transition from pediatric to adult care. There remains a gap in characterizing the parent experience during transition. This study describes the experiences of 13 mothers of young adults with inflammatory bowel disease during their child's transition. Most parents expressed fear and sadness about their child transitioning. Themes relating to involvement in their child's adult care included: direct involvement (sub-themes: disease management; logistics of care); and indirect involvement. Reasons for involvement included themes of parent's feelings and child's circumstances. Themes of involvement were discussed in terms of previous research on parenting of children with chronic disease. We suggest that future efforts focus on improving empathy and understanding toward parents of transitioning children and providing resources on how they can best support their child during transition and transfer to adult care.

Close outpatient follow-up associated with reduced readmission rates in patients with inflammatory bowel disease

Background Few studies have shown the effects of prompt outpatient follow-up in relation to reducing readmission rates in patients hospitalized with inflammatory bowel disease (IBD). Our study evaluated whether postdischarge follow-up was associated with fewer IBD-related readmissions. Methods This single-center retrospective study included 477 patients with Crohn’s disease (CD) or ulcerative colitis (UC) who were readmitted to our tertiary care hospital from January 1, 2016, to June 1, 2022. Rehospitalization admissions were defined as admissions that occurred within 90 days after discharge date. We used a chi-square or Fisher’s exact test to test for bivariate comparisons to determine if there was an association in patients readmitted for IBD and primary care or gastroenterology follow-up at 1, 2, 3, and 4 weeks versus no follow-up. Results In UC patients, there were 118 admissions from 2016 to 2022; 36/118 (31%) and 41/118 (34.7%) of the patients were readmitted at 30 days and 90 days, respectively. In the CD group, there were 101 (36.73%) readmissions among 277 patients, with 174 nonreadmissions (63.27%). Conclusions Gastroenterology follow-up within 1 month was associated with reduced rates of admission in both groups (P < 0.05). This study highlights the importance of close gastroenterology follow-up for IBD-related hospitalizations.

The Effect of an Electronic Medical Record-Based Clinical Decision Support System on Adherence to Clinical Protocols in Inflammatory Bowel Disease Care: Interrupted Time Series Study.

Clinical decision support systems (CDSSs) embedded in electronic medical records (EMRs), also called electronic health records, have the potential to improve the adoption of clinical guidelines. The University of Alberta Inflammatory Bowel Disease (IBD) Group developed a CDSS for patients with IBD who might be experiencing disease flare and deployed it within a clinical information system in 2 continuous time periods. This study aims to evaluate the impact of the IBD CDSS on the adherence of health care providers (ie, physicians and nurses) to institutionally agreed clinical management protocols. A 2-period interrupted time series (ITS) design, comparing adherence to a clinical flare management protocol during outpatient visits before and after the CDSS implementation, was used. Each interruption was initiated with user training and a memo with instructions for use. A group of 7 physicians, 1 nurse practitioner, and 4 nurses were invited to use the CDSS. In total, 31,726 flare encounters were extracted from the clinical information system database, and 9217 of them were manually screened for inclusion. Each data point in the ITS analysis corresponded to 1 month of individual patient encounters, with a total of 18 months of data (9 before and 9 after interruption) for each period. The study was designed in accordance with the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI) guidelines for health informatics evaluations. Following manual screening, 623 flare encounters were confirmed and designated for ITS analysis. The CDSS was activated in 198 of 623 encounters, most commonly in cases where the primary visit reason was a suspected IBD flare. In Implementation Period 1, before-and-after analysis demonstrates an increase in documentation of clinical scores from 3.5% to 24.1% (P<.001), with a statistically significant level change in ITS analysis (P=.03). In Implementation Period 2, the before-and-after analysis showed further increases in the ordering of acute disease flare lab tests (47.6% to 65.8%; P<.001), including the biomarker fecal calprotectin (27.9% to 37.3%; P=.03) and stool culture testing (54.6% to 66.9%; P=.005); the latter is a test used to distinguish a flare from an infectious disease. There were no significant slope or level changes in ITS analyses in Implementation Period 2. The overall provider adoption rate was moderate at approximately 25%, with greater adoption by nurse providers (used in 30.5% of flare encounters) compared to physicians (used in 6.7% of flare encounters). This is one of the first studies to investigate the implementation of a CDSS for IBD, designed with a leading EMR software (Epic Systems), providing initial evidence of an improvement over routine care. Several areas for future research were identified, notably the effect of CDSSs on outcomes and how to design a CDSS with greater utility for physicians. CDSSs for IBD should also be evaluated on a larger scale; this can be facilitated by regional and national centralized EMR systems.

Clinical Pharmacist Counselling Improves Long-term Medication Safety and Patient-reported Outcomes in Anti-TNF-treated Patients With Inflammatory Bowel Diseases: The Prospective, Randomized AdPhaNCED Trial.

Antitumor necrosis factor (anti-TNF) antibody treatment has led to marked improvements in the management of patients with inflammatory bowel diseases (IBDs). Nevertheless, anti-TNF therapy is associated with potential adverse drug reactions (ADRs). Our prospective, randomized trial investigated the effect of intensified clinical pharmacist counselling in a multidisciplinary team on medication safety in anti-TNF-treated IBD patients. Patients with IBD with ongoing anti-TNF treatment were enrolled in our tertiary center AdPhaNCED trial and randomized to either receive conventional standard of care (control group) or additional clinical pharmacist counselling (intervention group) over 12 months. The primary end point consisted of the number and severity of ADRs associated with anti-TNF therapy. Secondary end points included patient satisfaction with medication information and medication safety. One hundred twenty-seven IBD patients were included in this study. Anti-TNF-related ADRs were significantly lower in the intervention compared with the control group (0.20 vs 0.32 [mean] ADR/patient/month, P = .006) after 12 months. The risk of more severe ADRs (Common Terminology Criteria for Adverse Events [CTCAE] grade ≥2) was significantly higher in the control compared with the intervention group (hazard ratio, 0.34; P = .001). The probability of ADR resolution (hazard ratio, 2.02; P < .001) and patient satisfaction with medication information (14.82 vs 11.60; P < .001) were significantly higher in the intervention group compared with the control group. Our study results demonstrate that intensified pharmacist counselling significantly reduces the occurrence and severity of therapy-related ADRs and improves patient satisfaction. Clinical pharmacists should therefore be part of a holistic approach to IBD care delivered by a multidisciplinary team.

The current standard of care of inflammatory bowel disease

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Perspectives of patients, parents, and health care providers on facilitators of and barriers to the transition from pediatric to adult care in inflammatory bowel disease: a qualitative descriptive study

Abstract Background The typical transition from pediatric to adult care in patients with inflammatory bowel disease occurs with an increase in health care utilization and a decrease in adherence to medications and scheduled appointments. An effective transition could reduce negative impacts but requires identifying opportunities to improve this process. This study aims to describe barriers and facilitators of transition according to patients, parents, and health care providers. Methods This study used a qualitative description approach. The lead author conducted semi-structured interviews with 17 patients, 13 parents, and 15 providers recruited from Western Canada. Latent content analysis identified themes in interview transcripts. Results The theme of preparedness emerged across all groups as a transition facilitator. Other facilitators that emerged included patient characteristics, supportive parents, home environment, and supportive adult care team. Themes of barriers that emerged included patient factors, “hovering parents” and family factors, navigating a new health care system, and travel distance. Conclusions This study describes facilitators and barriers according to each stakeholder involved in the transition process. Future studies should focus on designing and evaluating interventions aimed at promoting facilitators and addressing identified barriers in patients preparing to transition from pediatric to adult care.

Inpatient management of iron deficiency anemia in pediatric patients with inflammatory bowel disease: A single center experience.

Screening for iron deficiency anemia (IDA) is important in managing pediatric patients with inflammatory bowel disease (IBD). Concerns related to adverse reactions may contribute to a reluctance to prescribe intravenous (IV) iron to treat IDA in this population. To track the efficacy and safety of IV iron therapy in treating IDA in pediatric IBD patients admitted to our center. A longitudinal observational cohort study was performed on 236 consecutive pediatric patients admitted to our tertiary IBD care center between September 2017 and December 2019. 92 patients met study criteria for IDA, of which 57 received IV iron, 17 received oral iron, and 18 were discharged prior to receiving iron therapy. Patients treated with IV iron during their hospitalization experienced a significant increase of 1.9 (± 0.2) g/dL in mean (± SE) hemoglobin (Hb) concentration by the first ambulatory follow-up, compared to patients who received oral iron 0.8 (± 0.3) g/dL or no iron 0.8 (± 0.3) g/dL (P = 0.03). One out of 57 (1.8%) patients that received IV iron therapy experienced an adverse reaction. Our findings demonstrate that treatment with IV iron therapy is safe and efficacious in improving Hb and iron levels in pediatric patients with IDA and active IBD.

Profile of Surgeons Who Treat Inflammatory Bowel Diseases in Brazil

Abstract Objective To describe the profile of surgeons who treat patients with inflammatory bowel disease as well as the characteristics of inflammatory bowel disease care, unmet demands, and difficulties. Methods The research participants answered a Google Forms questionnaire. Results Of the 99 surgeons who participated in the survey, 84.5% were coloproctologists, 40% were from the southeastern region of Brazil, and 77.7% were male and had been working for more than 19 years. Regarding the healthcare sector, 63.6% of surgeons worked in both public and private clinics, and most clinically cared for up to 50 patients with inflammatory bowel disease and operated on up to 5 cases per year. Conclusion This is the first national study that aimed to identify the profile of surgeons working with inflammatory bowel disease in Brazil. The vast majority are experienced male coloproctologists, located in the southern and southeastern regions, who perform clinical and surgical treatment of these pathologies, with major surgeries being performed in large centers by a small number of surgeons.

Impact of inflammatory bowel disease on the risk of acute coronary syndrome: A Swedish Nationwide Cohort Study.

There are conflicting data on the risk of acute coronary syndrome (ACS) in patients with inflammatory bowel disease (IBD). Only a few previous reports include patients diagnosed during the last decade. To assess and compare the risk of ACS between patients with IBD and the general population. In this cohort study, we used nationwide registers to identify patients diagnosed with IBD in Sweden 2003-2021. Every patient was matched by birth year, sex, calendar year and area of residence with up to 10 general population comparators. The primary outcome was incident ACS. We used semi-parametric Cox proportional hazard models to estimate hazard ratios (HRs). We identified 76,517 patients with IBD (Crohn's disease [CD], N = 22,732; ulcerative colitis [UC], N = 42,194 and IBD-unclassified, N = 11,591) and 757,141 comparators. During a median follow-up of 8 years, 2546 patients with IBD (37.5/10,000 person-years) were diagnosed with ACS compared with 19,598 (28.0/10,000 person-years) among comparators (HR 1.30; 95% confidence interval 1.24-1.35) after adjustments for confounding factors, and approximately one extra case of ACS in 100 IBD patients followed for 10 years. The highest HRs for ACS were in patients with elderly onset IBD (≥60 years) and among patients with CD or UC with extra-intestinal manifestations. No increased HRs were observed in patients diagnosed with IBD before the age of 40. In this contemporary cohort of patients with IBD, exposed to modern IBD care, there was an increased risk for ACS compared with individuals from the general population.

Non-invasive tools for inflammatory bowel disease: A systematic review and meta-analysis of biochemical markers and intestinal ultrasound compared to endoscopy

Despite endoscopy's gold standard status, non-invasive tools are revolutionizing Inflammatory Bowel Disease (IBD) management. This systematic review and meta-analysis compared the diagnostic accuracy of biochemical markers, intestinal ultrasound (US), and endoscopy in adults with IBD. This systematic review and meta-analysis aimed to compare the diagnostic accuracy of fecal calprotectin, C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), and bowel wall thickness measured by US with endoscopy in IBD patients. We searched electronic databases for most recent studies published between 2012 and 2023, identifying 25 studies comparing at least one non-invasive tool with endoscopy. We pooled sensitivity and specificity for relevant outcomes and conducted subgroup analyses to explore heterogeneity. 25 studies (n=5872 patients) met inclusion criteria. Fecal calprotectin emerged as a powerful diagnostic tool, with pooled sensitivity of 92.5% and specificity of 85.1% for IBD. But it’s performance was less consistent in differentiating active vs. inactive disease and predicting flares. Intestinal US proved reliable for diagnosis, particularly in Crohn's disease (pooled sensitivity 86.3%, specificity 78.9%), and showed promise in assessing activity and predicting treatment response. C-Reactive Protein and Erythrocyte Sedimentation Rate, though less accurate, provided additional information about disease status. Combining calprotectin and US further enhanced prediction accuracy, while decision tree analysis incorporating clinical data and both tools maximized prediction in ulcerative colitis. Non-invasive tools offer invaluable insights for IBD management, complementing and potentially reducing reliance on endoscopy. Standardizing methodologies and developing more specific markers, potentially aided by AI, holds immense potential for personalized, effective IBD care. This evolving landscape paves the way for a future where patients actively participate in their journey, empowered by the growing arsenal of non-invasive tools.

A225 ASSESSMENT OF BEDSIDE INTESTINAL ULTRASOUND IN MONITORING CROHN’S DISEASE ACTIVITY

Abstract Background Bedside intestinal ultrasound (IUS) is an evolving modality in monitoring disease activity and assessing complications in inflammatory bowel disease (IBD). The easy-tolerability and immediate accessibility to results for expedited clinical decision-making contribute to the growing global attraction of IUS integration into IBD care. Fecal calprotectin (FC) is a known, non-invasive tool to assess disease activity in IBD. However, it comes with limitations. Aims To assess the efficacy of IUS in monitoring Crohn’s Disease (CD) compared to FC level. Methods We conducted a retrospective observational study in patients with confirmed CD at a certified IUS gastroenterologist’s outpatient clinic in Saskatoon. Patients’ charts undergoing IUS between February 2022 and April 2023 were reviewed. Patients with CD and available FC results within a month of IUS performance were identified. Age, gender, disease character, clinical symptoms (Harvey-Bradshaw Index (HBI)), FC levels, and IUS bowel wall thickening (BWT) were collected. The cut-off for FC levels and BWT for disease activity were ampersand:003E250 μg/g and ampersand:003E3 mm, respectively. The correlation between IUS BWT and FC levels was analyzed based on the Pearson correlation. Results Among a total of 178 chart reviews, 71 patients were identified. The median age was 49 years, 52.1% were males and 47.8% were females. 35 (49.3%) ileal CD, 35 (49.3%) ileocolonic and 1 (1.4%) colonic CD were identified. The HBI score verified 67.6% mild disease, 19.7% moderate, 11.2% in remission, and 1.4% severe disease. The Pearson correlation coefficient (r) between FC levels and BWT findings on IUS was r = 0.29 (P ampersand:003C0.0001), indicating a weak positive correlation. Conclusions A positive but weak correlation exists between bowel wall thickening in IUS and FC level in monitoring CD. Recognizing FC limitations, future multi-center, larger cohort studies need to be done to investigate this correlation further. Funding Agencies None

Inflammatory Bowel Disease Hospitalizations Are Similar for Patients Receiving Televisit-Delivered Outpatient Care and Those Receiving Traditional In-Person Care.

The coronavirus disease 2019 pandemic resulted in widespread expansion of telehealth. However, there are concerns that telehealth-delivered outpatient care may limit opportunities for managing complications and preventing hospitalizations for patients with inflammatory bowel disease (IBD). We aimed to assess the association between outpatient IBD care delivered through televisit (video or phone) and IBD-related hospitalizations. We conducted a case-control study of patients with IBD who had an IBD-related index hospitalization between April 2021 and July 2022 and received their care in the Veterans Health Administration. We matched these hospitalized patients to controls who were not hospitalized based on age, sex, race, Charlson comorbidity index, IBD type, IBD-related emergency department use, IBD-related hospitalizations, and outpatient gastroenterology visits in the preceding year. The variable of interest was the percentage of total clinic visits delivered through televisit in the year before the index hospitalization. We compared the risk of IBD-related hospitalization by exposure to televisit-delivered care using conditional logistic regression. We identified 534 patients with an IBD-related hospitalization and 534 matched controls without an IBD-related hospitalization during the study period. Patients with IBD with a higher percentage of televisit-delivered (vs in-person) outpatient care were less likely to be hospitalized during the study period (for every 10% increase in televisit use, odds ratio 0.97, 95% confidence interval 0.94-1.00; P = 0.03). Televisit-delivered outpatient IBD care is not associated with higher risk of IBD-related hospitalization. These findings may reassure clinicians that televisit-delivered outpatient care is appropriate for patients with complex chronic diseases such as IBD.

UNCOVERING UNIQUE NEEDS AND BARRIERS TO CARE AMONG LGBTQ+ PATIENTS WITH IBD: INSIGHTS FROM A COMMUNITY SURVEY TO INFORM INCLUSIVE PRACTICES

Abstract INTRODUCTION Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals face a myriad of disparities and unique challenges that impact their clinical care and outcomes, however, less is known regarding the specific needs of sexual and gender minorities with inflammatory bowel disease (IBD). Methods: The aim of this study was to better understand the unmet needs and potential barriers to care that LGBTQ+ persons with IBD experience. A survey was disseminated in March 2023 via email distribution by Girls with Guts and the AIDS Institute to individuals with IBD who identify as LGBTQ+. The data was analyzed with descriptive analysis with frequencies and percentages (%). Results: A total of 217 people completed the survey, including 165 cisgender, 34 transgender, and 18 gender nonbinary individuals with IBD. The majority of respondents identified as lesbian or gay (56%) or bisexual (27%), and most reported an IBD diagnosis of Crohn’s Disease (61%). Most indicated their IBD care team was aware of their gender identity (76%) and sexual orientation (75%), either through direct discussions or being asked on medical forms, however nearly half report that they sometimes to very frequently delay seeking IBD care (49%) or refrain from sharing information with their IBD care team (63%) because of worry or fear of mistreatment or judgement (Figure 1). Only 37% of individuals agreed their IBD care team meets their unique needs as an LGBTQ+ person, and respondents reported most commonly turning to online sources of health information (55%) and other members of the LGBTQ+ community (42%) rather than their IBD care team (26%) for information on IBD as it relates to their gender, sexual orientation, and/or sexual practices. Overall, respondents most frequently cited worry about judgement or mistreatment (40%) as a barrier to discussing sexual orientation and gender identify (SOGI) with their IBD care team, however, this concern was more frequently reported by transgender (65%) and gender nonbinary (72%) individuals than cisgender persons (33%) (Figure 2). Nearly half (46%) agreed the clinic where they receive their IBD care could be described as LGBTQ+ safe and inclusive, however, this percentage varied by location, with individuals living in small towns or rural areas expressing more disagreement. Overall, respondents identified their IBD care teams could most improve by becoming more knowledgeable in LGBTQ+ concerns related to IBD (46%), initiating conversations related to SOGI and sexual practices (30%), and displaying visible signs of LGBTQ+ acceptance (29%). CONCLUSION Collectively, these data provide insight into the unique challenges and needs of LGBTQ+ individuals with IBD and may be used to inform strategies that support equitable IBD care. Future studies should focus on the impact of such strategies on IBD-related outcomes.

INCREASING ACCESS TO INTERDISCIPLINARY IBD CARE FOR NEWLY DIAGNOSED IBD PATIENTS USING TELEMEDICINE: AN EXTENSION OF THE COMPASS-IBD PROGRAM

Abstract INTRODUCTION Interdisciplinary care is increasingly being recognized as important in the care of inflammatory bowel disease (IBD) patients. However, access to additional resources to do this are frequently only available in tertiary-care IBD centers. We piloted a telemedicine version of an interdisciplinary care program for recently diagnosed IBD patients. METHODS The Mount Sinai Health system has a well-established IBD center, located at the Mount Sinai Hospital in New York. Patients who were diagnosed with IBD in the last 18 months were identified by a primary gastroenterologist working at a community site within the Mount Sinai health system. Once identified, patients were referred electronically and enrolled in the Comprehensive Care for the Recently Diagnosed IBD Patient (COMPASS-IBD) program. This existing program provides interdisciplinary care to newly diagnosed IBD patients. IBD patients have access to a physician who works at the IBD Center, a nutritionist specializing in IBD diets, an experienced IBD clinical pharmacist and a licensed clinical social worker dedicated to the mental and social needs of patients with IBD. After an initial assessment, these patients were then provided access as needed to the program experts. All appointments were done virtually using telemedicine. After completing intake, recommendations were consolidated and provided to the patient and the patient’s primary gastroenterologist electronically. The patient then followed up with his/her primary gastroenterologist. RESULTS For this pilot study, twelve newly diagnosed inflammatory bowel disease patients were identified at community sites within the Mount Sinai health system. Enrolled patients met with all members of the COMPASS- IBD program team for their initial intake. The referring gastroenterologist received summary recommendations for all patients who completed the intake. Participating patients were overall satisfied with the intervention and use of telemedicine as a primary modality. No major barriers to virtual program implementation were identified. DISCUSSION We demonstrated the feasibility of providing interdisciplinary care via telemedicine for recently diagnosed IBD patients. This supports a “hub and spoke” model for IBD care. We believe our pilot study shows a simple way for health systems to increase access to interdisciplinary IBD care for patients with limited access to tertiary-care IBD Centers. This approach may also help in achieving health equity for underserved IBD patient populations.

TELEHEALTH ENHANCES RETENTION OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE WITHIN A TERTIARY CARE INFLAMMATORY BOWEL DISEASE CENTER

Abstract INTRODUCTION Telehealth care in the ambulatory setting has dramatically increased in the COVID and post-COVID period in medicine. Understanding how this may impact the care of patients (pts) with inflammatory bowel disease (IBD) is important. This study aims to evaluate the pattern of use of telehealth care in a tertiary care IBD center. METHODS Pts seen at a tertiary care IBD center from January 2018 to March 2020 and August 2020 to January 2023 were included. Pts seen between March 2020 and July 2020 were excluded as the institution had mandatory telehealth visits during this period. Data was obtained from the Electronic Medical Record after IRB approval. Office visit types were based on billing codes, and office visits were only included in the analysis if seen by an MD or Advanced practice provider (APP). Drive time in minutes (min) was established from pt addresses using Esri geographic information systems (GIS) data, services and software. All new pts seen in the IBD Center are required to be seen in-clinic. After August 2020, pts seen in follow up can be seen at an in-clinic visit or via telehealth at the patient’s preference. Statistical analysis included Pearson Chi Square analysis for categorical variables and z-tests for means comparisons for continuous variables. RESULTS A total of 7,040 pts included. 56% were female. 89% were white, 7% Black or African American, and 76% had commercial health insurance, 17% had Medicare, 4% Medicaid, and 3% had no health insurance. New pts seen in the post-Covid period had shorter drive times than those seen in the pre-Covid period. (Table 1) Pts who had at least one year of follow up were more likely to be seen as a return visit in the post-Covid period vs the pre-Covid period (84% vs 76%, p&amp;lt;0.05). In the post-Covid period, 62% (3,575/5,750) pts had return IBD care by their MD or APP team delivered via telehealth. Pts seen in telehealth had significantly longer drive times than in-clinic-only pts (median 56.3 min [IQR 93.3] vs median 47.9 min [IQR 89.7]), p&amp;lt;0.001. (Table 2) This was significant for both the telehealth pts who had been seen in-clinic in the pre-Covid period as well as pts who were seen only in the post-Covid period. Pts who continued care only with in-clinic visits in the post-Covid period had significantly shorter drive times than pts who were seen in-clinic pre-Covid (38.8 min [IQR 60] vs 54.2 min [IQR 89.9]), p&amp;lt;0.001. CONCLUSION Telehealth is an effective strategy for continued multidisciplinary care at a tertiary care IBD center. More than half of patients continuing to participate in telehealth for follow up care, and patients were more likely to follow up in the post-Covid period. Patients who live farther away are more likely to continue IBD care via telehealth. Table 1 Overall Drive Time for New patients in the Pre- and Post-COVID periods Table 2 Drive Times for Return patients in the Pre-Covid and Post-Covid periods

EPIDEMIOLOGY OF INFLAMMATORY BOWEL DISEASE AMONG EARLY-INDUSTRIALIZED REGIONS OF THE WORLD: CHALLENGES IN SUSTAINABLE HEALTHCARE DELIVERY

Abstract BACKGROUND Early-industrialized regions (e.g., North America, Europe, Oceania) are currently in stage 3 of the epidemiologic evolution of inflammatory bowel disease (IBD), compounding prevalence wherein incidence stabilizes, but prevalence rises rapidly. This epidemiologic stage predicts the trajectory of healthcare infrastructure needs over the coming decades. AIMS 1. Describe current epidemiologic trends in representative stage 3 regions; 2. discuss ways to provide accessible, equitable, and quality IBD care in a sustainable manner; and 3. strategize future steps to prevent disease. METHODS The Canadian Gastro-Intestinal Epidemiology Consortium (CanGIEC) hosted IBD epidemiologists from representative stage 3 regions: Catalonia, Canada, Denmark, Hungary, Israel, New Zealand, Scotland, and the United States and address the rising burden of IBD. Epidemiologic data were reviewed in context using methodological differences between case ascertainment in each region to help explain heterogeneity (Table 1). Attendees engaged in a round-table consensus meeting, voting on priority needs to sustain IBD healthcare delivery given the trajectory of epidemiologic data. Four groups were formed with attendees of various backgrounds to encompass many perspectives, including epidemiologists, clinicians, IBD nurse practitioners, and patient advocates. RESULTS Table 1 describes IBD incidence and prevalence at the most recent year of historical data for each region. Canadian and Scottish studies included the forecasting of future prevalence estimates, a method that allows for proactive decision-making to accommodate the increasing number of individuals living with IBD. In 2028, the forecasted prevalence of IBD in Lothian, Scotland, was 1,023 per 100,000; and in 2030, the forecasted prevalence of IBD in Canada was 981 per 100,000. Table 2 describes the topics brought up in response to the aims, and the level of priority. Limited resources for a growing IBD population are a major cause for concern, negatively impacting access to and quality of care. To optimize quality of care, a multidisciplinary team approach is necessary. Suggestions for support in managing mild IBD cases include virtual care and remote monitoring, nurse-driven clinics, and cooperation with primary care physicians; this would help free-up in-person appointments with specialists for moderate-to-severe cases. Interventions that prevent IBD through modifying environmental and behavioral determinates, will have the largest impact on decelerating prevalence rates over time. DISCUSSION Forefront at the meeting was the fact of the continuing rise of IBD prevalence, augmenting the challenges faced by healthcare systems and practitioners. There are plausible and actionable solutions to achieve successful management of IBD upon initiating changes in healthcare policy.