Laurie Keefer, PhD1, Ksenia Gorbenko, PhD2, Tina Siganporia, MA2, Stacy Tse, PharmD2, Louis Cohen, MD2, Ryan Ungaro, MD2, Benjamin Cohen, MD3, Marla C. Dubinsky, MD2; 1Icahn School of Medicine at Mount Sinai, West Caldwell, NJ; 2Icahn School of Medicine at Mount Sinai, New York, NY; 3Cleveland Clinic Foundation, Cleveland, OH
Introduction: IBD imposes substantial financial burden on patients, employers and the health system. Patients with behavioral comorbidity pose 3 to 5 times the financial burden in the form of emergency visits and hospital admissions; risk mitigation requires behavioral health intervention and intensive care coordination. We evaluated if The GRITT Method, a resilience-based care coordination approach to chronic disease, could reduce health care utilization (HCU) in psychosocially complex IBD. Methods: Consecutive patients with IBD, age 18-70, from an academic IBD Center (August 2016-July 2019) screening positive for low resilience [GRITT Score] were eligible. Demographics, emergency department (ED) visits and hospital admissions in 12 months prior to enrollment were collected from the chart at baseline. The GRITT team developed a personalized care plan based on GRITT Score and team discussion. The GRITT team including nutrition, social work, nursing, pharmacy and psychology implemented personalized care plans over 6 months; charts were re-evaluated for HCU 1 year after enrollment. Descriptive statistics summarized patient data and univariate analysis compared % reduction in ED and hospital admissions between GRITT graduates and controls (eligible but did not engage) at 1 year follow-up, and demographic differences between groups. A paired sample t-test evaluated change in GRITT Score. Results: Total 336 patients (62%CD, 58%F), mean age 34.8 [18-66] were eligible:126 patients (38%) engaged and graduated from the program, 210 served as controls (Table 1). Reasons for non-engagement: non-local (38%), lack of/limited insurance coverage/high deductible (30%), declined (24%), lost to follow-up (8%). Controls were more likely to have UC, be male, and non-commercially insured. Graduates saw 90% reduction in ED Visits (p< .001) and 88% reduction in hospitalizations (p< .001); Controls saw 4% reduction in ED Visits (p=ns) and 65% increase in hospitalizations (p< .001) (Fig. 1). Graduates had increase in GRITT Score of 33 points, reflecting improved resilience (p < .001). Discussion: The GRITT Method, focused on resilience building and care coordination was associated with a reduction in ED visits and hospital admissions in a high need, high cost patient population. Efforts to increase engagement, reduce geographic barriers to participation and scale care coordination are underway.
Table 1. Demographics by group
Figure 1. Comparison of % reduction in health care use over time between GRITT Graduates and Controls
Disclosures: Laurie Keefer: Trellus Health – Advisory Committee/Board Member, Stockholder/Ownership Interest (excluding diversified mutual funds). Ksenia Gorbenko indicated no relevant financial relationships. Tina Siganporia indicated no relevant financial relationships. Stacy Tse indicated no relevant financial relationships. Louis Cohen indicated no relevant financial relationships. Ryan Ungaro: AbbVie – Grant/Research Support. Eli Lilly – Consultant. Pfizer – Consultant, Grant/Research Support. Takeda – Consultant. Benjamin Cohen indicated no relevant financial relationships. Marla Dubinsky: Trellus Health – Stockholder/Ownership Interest (excluding diversified mutual funds).