RESUMEN
INTRODUCTION: A multicenter adult inflammatory bowel disease learning health system (IBD Qorus) implemented clinical care process changes for reducing unplanned emergency department visits and hospitalizations using a Breakthrough Series Collaborative approach. METHODS: Using Markov decision models, we determined the health economic impact of participating in the Collaborative from the third-party payer perspective. RESULTS: Across all 23 sites, participation in the Collaborative was associated with lower annual costs by an average of $2,528 ± $233 per patient when compared with the baseline period. DISCUSSION: Implementing clinical care process changes using a Collaborative approach was associated with overall cost savings. Future work should examine which specific interventions are most effective and whether such cost savings are sustainable.
Asunto(s)
Atención a la Salud/organización & administración , Costos de la Atención en Salud , Hospitalización/tendencias , Enfermedades Inflamatorias del Intestino/economía , Aceptación de la Atención de Salud/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud/normas , Adulto , Enfermedad Crónica , Ahorro de Costo , Femenino , Humanos , Incidencia , Enfermedades Inflamatorias del Intestino/epidemiología , Enfermedades Inflamatorias del Intestino/terapia , Masculino , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: Intestinal endometriosis (IE) can present with varied symptoms, making the diagnosis difficult. Modalities have been described to evaluate IE, but few can provide a confirmatory diagnosis. A preoperative diagnosis of IE may help guide management. We sought to describe the presentation, diagnostic evaluation, histology and operative management of 89 patients with tissue-confirmed symptomatic IE. METHODS: The records of 89 patients from a single institution with histologically confirmed, symptomatic IE from 1 January 1994 to 30 September 2009 were reviewed. RESULTS: Abdominal pain was the most common symptom in patients with IE; however, rectal bleeding was significantly associated with IE of the distal colon (P=0.02), while dysfunctional uterine bleeding was seen more in patients with proximal IE (P=0.01). Preoperative confirmation of IE was uncommon; colonoscopy with biopsy confirmed the diagnosis in 29.6% of patients tested and only 15% of patients with IE had histologic lesions involving mucosa. In the five patients who underwent endoscopic ultrasound (EUS), the diagnosis of IE was established in all cases (n=4) where histology or cytology was obtained. Malignancy was considered nearly as frequently as IE preoperatively, and 90.4% of patients underwent laparotomy as the initial surgical approach. CONCLUSIONS: IE can present with a variety of manifestations, which may provide clues to location of bowel affected. Patients with known pelvic endometriosis and rectal bleeding are more likely to have distal bowel affected; EUS with tissue sampling may play a role if routine endoscopy fails to reveal the diagnosis. Making a diagnosis of IE preoperatively may allow for less invasive surgical approaches and better patient outcomes.