Resilience Proves To Have Positive Effects on Symptoms and Costs of IBD
Named the Best In Category for Inflammatory Bowel Disease (IBD) in the Presidential Plenary sessions at the American College of Gastroenterology (ACG) 2020 Clinical Meeting, “A Resilience-Based Care Coordination Program Has Positive and Durable Impact on Health Care Utilization in Inflammatory Bowel Diseases” demonstrated how helping patients achieve and maintain positive psychology can improve not only their quality of life but also their clinical symptoms and health care utilization.
The oral presentation was made by Laurie Keefer, PhD, from the Icahn School of Medicine at Mount Sinai in New York City.
She noted that the Crohn’s and Colitis Foundation (CCF) found that IBD costs in the United States amount to approximately $51 billion per year; of the $46 billion in direct costs for IBD, $41 billion can be attributed to patients defined as ‘high utilizers’ of health care services, and the difference between high and low utilizers is largely driven by mental health. Only 15% of patients account for 50% of the costs associated with the treatment of IBD, and costs of treating gastrointestinal conditions are 5 times higher when patients evidence mental health comorbidities, according to a study by Miguel Regueiro, MD, and colleagues.
Dr Keefer explained that, at Mount Sinai Medical Center, her team asked a different question: Who are the low utilizers, and what do they have that the high utilizers do not? A previous study of 200 patients at Mount Sinai showed that patients who demonstrated high resilience, defined as the ability to thrive under adverse circumstances, had better health outcomes.
Dr Keefer and colleagues at Mount Sinai developed the multidisciplinary "Gaining Resilience Through Transitions in Cases of Inflammatory Bowel Disease"(GRITT-IBD) program, a positive psychology approach to helping patients with IBD build their resilience. Patients are stratified according to their physical health indicators as well as factors that indicate their resilience. Those with low GRITT scores received a “playbook” that is implemented by a team of social workers, nurse specialists, dieticians, and nurse specialists, designed to help these patients focus on positive psychology and improve resilience. The specific resilience targets are acceptance, optimism, self-efficacy, social support, and self-regulation.
After patients reach these targets on the GRITT score, the team then maintains tight control by reassessing for resiliency periodically, particularly in transitional situations that could affect the patients’ ability to self-regulate and maintain resilience, such as pregnancy and job change.
The research team reviewed outcomes such as emergency department visits and hospitalizations among 126 GRITT program graduates and a control group of 206 patients with IBD who could have participated but did not. They examined the 12 months prior to enrollment in the GRITT program and the 12 months following, specifically reviewing health care utilization as measured by emergency department visits and hospitalizations.
“The GRITT group had dramatic reductions in health care utilization—a 90% drop in emergency department visits and an 88% drop in hospitalizations,” Dr Keefer explained. “The control group did not see any shift in their unplanned care. As a secondary outcome, those in the GRITT program normalized their resilience scores. They scored above 70 at graduation, which suggests that resilience may indeed have influenced the health-related outcomes.”
Keefer L, Gorbenko K, Siganporia T, et al. A resilience-based care coordination program has a positiveand durable impact on health care utilization in inflammatory bowel diseases. Talk presented at: American College of Gastroenterology Clinical Meeting and Postgraduate Course, October 27, 2020. Virtual.