Care Coordination and Proactive Care to Improve Utilization of Resources and Reduce Expenditure in High Risk Inflammatory Bowel Disease (IBD) Patients (CAPTURE IBD)
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|ClinicalTrials.gov Identifier: NCT04796571|
Recruitment Status : Completed
First Posted : March 15, 2021
Last Update Posted : March 15, 2021
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|Condition or disease||Intervention/treatment||Phase|
|Inflammatory Bowel Diseases||Behavioral: Proactive Symptom Monitoring and Care Coordination||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||425 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Double (Investigator, Outcomes Assessor)|
|Masking Description:||Blinding of participants was not possible because telephone visits were only offered to participants in the intervention arm. Investigators were blinded to the randomization order, but patients, staff, and providers were not blinded to arm assignment. The investigators who validated the data and performed the data analysis remained blinded to patient group assignment.|
|Primary Purpose:||Supportive Care|
|Official Title:||Care Coordination and Proactive Care to Improve Utilization of Resources and Reduce Expenditure in High Risk Inflammatory Bowel Disease (IBD) Patients|
|Actual Study Start Date :||January 1, 2019|
|Actual Primary Completion Date :||March 1, 2020|
|Actual Study Completion Date :||March 1, 2020|
Experimental: Care Coordination Arm
Patients were assigned an IBD-focused care coordinator who facilitated a symptom-based monitoring algorithm and supported patient navigation to complement usual care.
Behavioral: Proactive Symptom Monitoring and Care Coordination
Patients randomized to the intervention arm were assigned an IBD-focused care coordinator who facilitated a symptom-based monitoring algorithm and supported patient navigation to complement usual care. Symptom monitoring was facilitated through regular push notifications to participants to complete a validated PRO instrument through the Epic EMR patient portal or telephone. These notifications were scheduled on a monthly basis. The IBD-focused care coordinator made two attempts to reach each participant using portal messaging, followed by a phone call to reduce non-response. PRO questionnaires were reviewed by the care coordinator and out of range scores triggered algorithm-based recommendations to the IBD specialist including stricter monitoring of disease activity, behavioral and medication adherence counseling, facilitation of expedited follow-up with treating providers, and referrals to social work, mental health, and gastroenterology-specific behavioral health services.
No Intervention: Usual Care
Participants in the usual care arm underwent symptom monitoring through regular push notifications to participants to complete a validated PRO instrument through the Epic EMR patient portal or telephone. These notifications were scheduled on a monthly basis. Results of the monthly PRO instrument were available to their treating IBD doctor with interventions at their discretion.
No Intervention: passive control arn
To explore whether our usual care arm was influenced by the monthly PRO measurements required for examination of our primary outcome, we compared IBD charges, total charges, ED visits, hospitalizations, and medication utilization at 12 months in the usual care arm to a passive control arm consisting of patients who met eligibility criteria, but were not enrolled in the intervention or usual care arms.
- Change in patient reported outcome (PRO) scores [ Time Frame: 9 months ]
Patient Reported Outcome (PRO) measurements were administered on a monthly basis. The validated Crohn's (CD)-PRO or ulcerative colitis (UC)-PRO were used according to the patient's IBD type (Crohn's or ulcerative colitis).
Both the CD-PRO and UC-PRO are a set of standardized and validated instruments based on the Crohn's Disease Activity Index and Mayo Clinic Score respectively, which includes six domains: daily bowel movements, functional symptoms, systemic symptoms, daily coping, weekly life impact, and weekly emotional impact. Scores are calculated a composite score across all domains where a score of 0 represents no symptom activity and a score of 40 represents the highest possible symptom burden.
These were not two separate outcomes, rather two independent measurement instruments (scored on the same scale) specific to the patient's IBD-type to address the specific needs/concerns of the patients based on disease type.
- IBD-related charges per person [ Time Frame: 12 months ]extracted charges where IBD was the primary diagnosis over study period
- Total healthcare charges per person [ Time Frame: 12 months ]all extracted charges over study period
- Emergency Department (ED) visits per person [ Time Frame: 12 months ]extracted number of persons experiencing an ED visit over the study period
- Proportion of hospitalizations per person [ Time Frame: 12 months ]extracted number of persons experiencing hospitalization over the study period
- Change in IBD medication utilization [ Time Frame: 12 months ]Use of any of the following medications: biologic therapy, immunosuppressant therapy, corticosteroids, narcotics over study period
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|Ages Eligible for Study:||18 Years to 90 Years (Adult, Older Adult)|
|Sexes Eligible for Study:||All|
|Accepts Healthy Volunteers:||No|
- established diagnosis of IBD (with at least 3 office visits)
- followed in GI clinic within 1 year of enrollment
- in top 20th percentile of predicted risk for subsequent healthcare utilization (previously validated model)
- non-IBD driver for high utilization (e.g., active cancer undergoing treatment
- A life expectancy of less than one year, were excluded from participation.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04796571
|United States, Michigan|
|University of Michigan|
|Ann Arbor, Michigan, United States, 48103|
|Principal Investigator:||Peter Higgins, MD, PhD, MSc||University of Michigan|
|Responsible Party:||Peter Higgins, Professor of Internal Medicine, University of Michigan|
|Other Study ID Numbers:||
|First Posted:||March 15, 2021 Key Record Dates|
|Last Update Posted:||March 15, 2021|
|Last Verified:||March 2021|
|Individual Participant Data (IPD) Sharing Statement:|
|Plan to Share IPD:||No|
|Plan Description:||There is no plan to share this PHI data with the public, however it there is a request, de-identified data could be arranged.|
|Studies a U.S. FDA-regulated Drug Product:||No|
|Studies a U.S. FDA-regulated Device Product:||No|
Inflammatory Bowel Diseases
Digestive System Diseases