TY - JOUR
T1 - Variation Between Hospitals in Outcomes and Costs of IBD Care
T2 - Results From the IBD Value Study
AU - Southwest Netherlands IBD Study Group
AU - Van Linschoten, Reinier C.A.
AU - Van Der Woude, C. Janneke
AU - Visser, Elyke
AU - Van Leeuwen, Nikki
AU - Bodelier, Alexander G.L.
AU - Fitzpatrick, Claire
AU - De Jonge, Vincent
AU - Vermeulen, Hestia
AU - Verweij, K. Evelyne
AU - Van Der Wiel, Sanne
AU - Nieboer, Daan
AU - Birnie, Erwin
AU - Van Der Horst, Daniëlle
AU - Hazelzet, Jan A.
AU - Van Noord, Desirée
AU - West, Rachel L.
N1 - Publisher Copyright:
© 2024 Crohn's & Colitis Foundation.
PY - 2025/2/1
Y1 - 2025/2/1
N2 - Background: Data on variation in outcomes and costs of the treatment of inflammatory bowel disease (IBD) can be used to identify areas for cost and quality improvement. It can also help healthcare providers learn from each other and strive for equity in care. We aimed to assess the variation in outcomes and costs of IBD care between hospitals.Methods: We conducted a 12-month cohort study in 8 hospitals in the Netherlands. Patients with IBD who were treated with biologics and new small molecules were included. The percentage of variation in outcomes (following the International Consortium for Health Outcomes Measurement standard set) and costs attributable to the treating hospital were analyzed with intraclass correlation coefficients (ICCs) from case mix-adjusted (generalized) linear mixed models.Results: We included 1010 patients (median age 45 years, 55% female). Clinicians reported high remission rates (83%), while patient-reported rates were lower (40%). During the 12-month follow-up, 5.2% of patients used prednisolone for more than 3 months. Hospital costs (outpatient, inpatient, and medication costs) were substantial (median: €8323 per 6 months), mainly attributed to advanced therapies (€6611). Most of the variation in outcomes and costs among patients could not be attributed to the treating hospitals, with ICCs typically between 0% and 2%. Instead, patient-level characteristics, often with ICCs above 50%, accounted for these variations.Conclusions: Variation in outcomes and costs cannot be used to differentiate between hospitals for quality of care. Future quality improvement initiatives should look at differences in structure and process measures of care and implement patient-level interventions to improve quality of IBD care. Trial Registration Number: NL8276.
AB - Background: Data on variation in outcomes and costs of the treatment of inflammatory bowel disease (IBD) can be used to identify areas for cost and quality improvement. It can also help healthcare providers learn from each other and strive for equity in care. We aimed to assess the variation in outcomes and costs of IBD care between hospitals.Methods: We conducted a 12-month cohort study in 8 hospitals in the Netherlands. Patients with IBD who were treated with biologics and new small molecules were included. The percentage of variation in outcomes (following the International Consortium for Health Outcomes Measurement standard set) and costs attributable to the treating hospital were analyzed with intraclass correlation coefficients (ICCs) from case mix-adjusted (generalized) linear mixed models.Results: We included 1010 patients (median age 45 years, 55% female). Clinicians reported high remission rates (83%), while patient-reported rates were lower (40%). During the 12-month follow-up, 5.2% of patients used prednisolone for more than 3 months. Hospital costs (outpatient, inpatient, and medication costs) were substantial (median: €8323 per 6 months), mainly attributed to advanced therapies (€6611). Most of the variation in outcomes and costs among patients could not be attributed to the treating hospitals, with ICCs typically between 0% and 2%. Instead, patient-level characteristics, often with ICCs above 50%, accounted for these variations.Conclusions: Variation in outcomes and costs cannot be used to differentiate between hospitals for quality of care. Future quality improvement initiatives should look at differences in structure and process measures of care and implement patient-level interventions to improve quality of IBD care. Trial Registration Number: NL8276.
KW - advanced therapy
KW - inflammatory bowel disease
KW - quality improvement
KW - value-based healthcare
KW - variation
UR - https://www.scopus.com/pages/publications/85217717687
U2 - 10.1093/ibd/izae095
DO - 10.1093/ibd/izae095
M3 - Article
C2 - 38666643
AN - SCOPUS:85217717687
SN - 1078-0998
VL - 31
SP - 332
EP - 343
JO - Inflammatory Bowel Diseases
JF - Inflammatory Bowel Diseases
IS - 2
ER -