Resilience-based Integrated IBD Care Is Associated With Reductions in Health Care Use and Opioids
Laurie Keefer,* Ksenia Gorbenko,* Tina Siganporia,* Laura Manning,* Stacy Tse,*
Anthony Biello,* Ryan Ungaro,* Louis J. Cohen,* Benjamin L. Cohen,‡ and
Marla C. Dubinsky*
*Division of Gastroenterology and Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York; and ‡Cleveland Clinic, Department of Gastroenterology, Hepatology and Nutrition, Cleveland, Ohio
BACKGROUND & AIMS:
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 3 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.
Keywords: Emergency Department Use; Hospitalizations; Opioid Use; Crohn’s Disease; Ulcerative Colitis; Depression; Positive Psychology; Mind-Body Intervention.