title: A chronic care model significantly decreases costs and healthcare utilisation in patients with inflammatory bowel disease.
abstract: BACKGROUND
  Inflammatory bowel disease (IBD) is a chronic condition, yet the model of care is often reactive. We sought to examine whether a formal IBD service (IBDS) reduced inpatient healthcare utilisation or lowered costs for inpatient care.
  
  
  METHODS
  With protocols, routine nurse phone follow-up a help-line, more proactive care was delivered, with many symptoms and concerns dealt with prior to routine presentation. Over two five month periods before (2007/8) and after (2009/10) introducing a formal IBDS two discrete cohorts of admitted IBD patients were identified at a single centre. Each patient was assigned five contemporaneously admitted, age and gender matched controls. Inpatient healthcare utilisation was compared between patients and controls and disease-specific factors amongst the two IBD cohorts.
  
  
  RESULTS
  The initial audit captured 102 admitted IBD patients (510 controls, median age 44 years, 57% female); the second audit 95 patients (475 controls, median age 46 years, 45.3% female). In 2009/10, the number of admissions was lower in IBD patients than in controls (mean 1.53+/-1.03 vs. 2.54+/-2.35; p<0.0001). This contrasts with the first audit, where IBD patients had more admissions than controls. Following IBDS introduction, the mean total cost of inpatient care was lower for IBD patients than controls (US$12,857.48 (US$15,236.79) vs. US$ 30,467.78 (US$ 53,760.20), p=0.005). In addition, patients known to a specialist gastroenterologist (GE) and the IBD Service tended to have the lowest mean number of admissions (GE and IBDS 1.14 (+/-0.36) vs. no GE/IBDS 1.64 (+/-1.25)).
  
  
  CONCLUSIONS
  Healthcare utilisation and disease burden in IBD decreased significantly since introducing an IBDS. These data suggest that proactive management improved outcomes. Contact with a gastroenterologist and IBDS seemed to give best results.
authors.affiliation: IBD Service, Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Sack
authors.forename: V A
authors.initials: VA
authors.lastname: Phan
authors.forename: R
authors.initials: R
authors.lastname: Grafton
authors.forename: G
authors.initials: G
authors.lastname: Holtmann
authors.forename: D R
authors.initials: DR
authors.lastname: van Langenberg
authors.forename: K
authors.initials: K
authors.lastname: Brett
authors.forename: M
authors.initials: M
authors.lastname: Clark
authors.forename: J M
authors.initials: JM
authors.lastname: Andrews
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000191:economics* / Q000628:therapy*; D007902:Length of Stay / Q000191:economics* / Q000639:trends; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D010343:Patient Admission / Q000191:economics* / Q000639:trends; D010353:Patient Education as Topic; D018709:Statistics, Nonparametric