Towards Value Based Care for inflammatory bowel diseases with the Telemedicine tool myIBDcoach
IMID (immune mediated chronic inflammatory diseases) is a term used to describe a group of chronic, highly disabling diseases that affect different organ systems and often start at a young age. Inflammatory bowel disease (IBD) is a group of chronic, relapsing IMIDS of the gut, with Crohn’s disease (CD) and ulcerative colitis (UC) being the main subtypes. Treatment of symptoms alone did not improve the long-term disease course of IBD sufficiently and data on patient reported outcome measures (PROMs) are lacking. To improve outcome, recent guidelines advice tight control of mucosal inflammation and of all disease aspects that might influence activity. Collecting all the necessary information at the right time in a traditional setting is however challenging and increases hospital visits and costs. To enable continues monitoring of inflammation and relevant PROMs and PREMs we developed through close collaboration of patients and healthcare professionals the telemedicine tool MyIBDCoach. The aim of this project was to validate the effects of myIBDcoach compared to standard care on healthcare utilisation and patient-reported quality of care (PRQoC) in a pragmatic randomised trial.
Methods: IBD patients visiting the outpatient clinic of 2 academic and 2 non-academic hospitals in The Netherlands, aged 18–75 years, with internet-access and Dutch proficiency, were eligible for inclusion. Patients were randomised to myIBDcoach or standard care and followed for 12 months. Primary outcomes were number of outpatient visits and PRQoC. Secondary outcomes were the conventional disease outcomes, medication adherence, quality of life and self-efficacy (ClinicalTrials.gov NCT02173002).
Main Results: Between September 2014 and May 2015, patients were randomised to myIBDcoach (n=465) or standard care (n=444). In the myIBDcoach group we found after 12 months a 36% reduction in outpatient visits, a 31% reduction in telephone consultations and a 50% reduction in hospitalisations and increased adherence to medication. Both groups reported equal high PRQoC scores. No differences were observed in the conventional outcomes; disease flares, corticosteroid use, emergency visits or surgeries.
Interpretation: To ensure high quality and affordable care for every patient with a IMID in the future reorganisation of healthcare is warranted. We showed in a large randomised controlled trial that telemedicine through myIBDcoach was safe, reduced health care utilisation, and improved adherence with equal PRQoC compared with standard care. MyIBDcoach enables efficient continuous monitoring of all relevant PROMs and PREMS. At present already 6 academic and non-academic hospitals use myIBDcoach in routine care. A value-based health care project with myIBDcoach at the MUMC+ evaluating all direct and indirect health care costs in relation with disease outcomes and PREMs will start in 2017.