Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, is a chronic disease that afflicts 3 million patients in the United States. Many IBD patients also have behavioral health (BH) conditions, such as depression or anxiety, which can have a negative impact on their lives if left untreated. Specialty medical homes (SMHs) are healthcare clinics designed to provide care focused on the whole person throughout an individual’s lifelong disease course, including addressing BH concerns. SMH models are shown to improve quality of care and health outcomes, although SMHs for IBD have yet to become widely available for patients, likely due to healthcare systems not yet knowing how best to organize and deliver care in a way that includes more options such as telemedicine and interactive treatment technologies. More information is needed to inform both patients and healthcare delivery systems of the benefits of SMHs to enable them to become more widely available to ensure that patients get the right care, at the right time, and in the right way to manage their physical and BH conditions.
This research collaboration, informed by many stakeholders, including patients with IBD and other chronic conditions, involves IBD clinics in three large cities to compare two different SMH approaches for patients with IBD and BH conditions—a traditional medical clinic team (TEAM) approach and a health technology-based (TECH) approach that uses remote monitoring and web-based treatment technologies. In response to the documented needs of patients with IBD and other key stakeholders, this real-world study will provide useful information about available options for supporting individuals with IBD to make choices and receive the best possible care. We will enroll 900 patients aged 18–60 who have been diagnosed with IBD and BH conditions and who, after being informed about study details and providing consent, will be randomly assigned to one of the two approaches. We will assess the impact of TEAM and TECH on patient-centered outcomes including IBD and BH severity, functional impairment, healthcare use, quality of life, and patient disease self-management. We will also determine which option works best for which patients by gathering information directly from individuals with IBD through self-report questionnaires, clinical data, and interviews with patients and providers.
If the approaches are shown to improve health outcomes, we are prepared to share a “how-to” toolkit with IBD centers across the United States and build partnerships to explore how SMHs can benefit patients with other diseases. Patients and other stakeholders have contributed and will continue to contribute to all phases of our work. Our study team includes a patient co-investigator, patient partners, and an advisory board that includes a wide range of organizations and individuals who are deeply committed to this work.