Abstract
Background
Inflammatory Bowel Disease (IBD) patients often have disease flares and extraintestinal manifestations such as rashes, arthralgias & perianal fistulas that require timely assessments. We implemented a Rapid Interdisciplinary IBD program at Mount Sinai Hospital with expedited consultation by an IBD specialist and referral with clinical need to collaborative colorectal surgeon, dermatologist, rheumatologist, and/or high-risk obstetrician. The RAPID program includes an online IBD Dashboard for patients to respond to questionnaires which is closely monitored 90 days post-enrolment by the IBD nurse.
Aims
To assess the implementation of an Interdisciplinary IBD Clinic & online IBD Dashboard monitoring system on the ability to increase patient satisfaction regarding their IBD care.
Methods
Upon consent into the RAPID IBD program, patients are enrolled to the IBD Dashboard and complete a Patient Satisfaction (CACHE) questionnaire at baseline, 3, 6, 12 months follow up and clinical disease activity scores at baseline, 1, 2, 3 months post enrollment; the Modified Harvey Bradshaw Index (mHBI) for Crohn’s disease (CD); partial Mayo score and Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis (UC) and IBD unclassified (IBDU) patients. Results were compared pre/post enrollment with changes in median and interquartile ranges (IQR).
Results
109 patients were referred to RAPID, 88 (49 CD, 33 UC, 6 IBDU) enrolled & 62 consented to IBD Dashboard monitoring. Of those enrolled, 40 patients were referred based on flaring of clinical scores, 23 with potential flare or complication, 17 with acute extraintestinal manifestations, 4 pregnant and 4 with perianal disease. Median 4 (2–7) days to first GI IBD clinic. 15 patients were referred to dermatology, 12 to colorectal surgery, 8 to rheumatology and 3 to obstetrics. 6 patients visited the ER within the first 90 days after enrollment, with 1 (1–2) ER visits. Patient satisfaction improved from baseline 73.5% (68.4%-77.4%) (n=53) to 82.3% (75.5% - 84.0%) at 3 months (n=28). Clinical responses were seen post enrollment with a decrease in mHBI of 3.0 at 2 months, 1.5 on the 6-point Mayo (SF + RB) at 1 & 3 months and patient defined significant improvement in SCCAI greater than 1.5 after 1 month.
Conclusions
Preliminary results with RAPID IBD program demonstrate a short time to be seen by an IBD specialist, improvement in patient satisfaction and clinical responses in mHBI, pMayo and SCCAI scores 1–3 months post enrollment.
Disease Activity Index Scores, MSH RAPID IBD Clinic
| Disease Activity Index | Baseline [n] | 1 Mo. [n] | 2 Mo. [n] | 3 Mo. [n] |
| mHBI | 7.0 (4.0–10.0) [27] | 6.0 (5.5- 9.5) [15] | 4.0 (2.0–8.5) [19] | 2.0 (1.0–4.0) [12] |
| Mayo (SF + RB) | 2.5 (1.0–4.0) [34] | 1.0 (0.0–5.0) [13] | 2.0 (0.5–3.5) [15] | 1.0 (0.0–3.0) [15] |
| SCCAI | 6.0 (3.0–8.0) [32] | 2.5 (2.0–5.0) [8] | 4.0 (1.5 – 5.0) [11] | 3.0 (1.0–6.5) [15] |
Funding Agencies
AMO