The clinical utility of health-related quality of life screening in a pediatric inflammatory bowel disease clinic.
BACKGROUND
Adjusting to symptom flares, treatment regimens, and side effects places youth with inflammatory bowel disease (IBD) at increased risk for emotional and behavioral problems and adverse disease outcomes. Implementation of psychosocial screening into clinical practice remains a challenge. This study examines the clinical utility of health-related quality of life (HRQOL) screening in predicting disease outcome and healthcare utilization.


METHODS
One hundred twelve youth of 7 to 18 years diagnosed with IBD and their parents. Youth completed standardized measures of HRQOL and depression. Parents completed a proxy report of HRQOL. Pediatric gastroenterologists provided the Physician Global Assessment. Families were recruited from a pediatric gastroenterology clinic. Retrospective chart reviews examined disease outcome and healthcare utilization for 12 months after baseline measurement.


RESULTS
Linear regressions, controlling for demographic and disease parameters, revealed that baseline measurement of youth and parent proxy-reported HRQOL predicted the number of IBD-related hospital admissions, gastroenterology clinic visits, emergency department visits, psychology clinic visits, telephone contacts, and pain management referrals over the next 12 months. Disease outcome was not significant.


CONCLUSIONS
Lower HRQOL was predictive of increased healthcare utilization among youth with IBD. Regular HRQOL screening may be the impetus to providing better case management and allocating resources based on ongoing care needs and costs. Proactive interventions focused on patients with poor HRQOL may be an efficient approach to saving on healthcare costs and resource utilization.
*Department of Psychology, Oklahoma State University, Stillwater, Oklahoma; †Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; ‡Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; §Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and ‖Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Jamie L
JL
Ryan
Michael W
MW
Mellon
Katherine W F
KW
Junger
Elizabeth A
EA
Hente
Lee A
LA
Denson
Shehzad A
SA
Saeed
Kevin A
KA
Hommel
D000223:Adaptation, Psychological; D000293:Adolescent; D002648:Child; D003093:Colitis, Ulcerative / Q000150:complications / Q000523:psychology*; D003424:Crohn Disease / Q000150:complications / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000175:diagnosis* / Q000523:psychology