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Physicians Update

 
Winter 2013

Center Takes New Approach to Care of Patients with IBD

UCLA Center for Inflammatory Bowel DiseasesA novel program in which patients with inflammatory bowel disease (IBD) use technology to learn about their disease and log values on symptoms, quality of life and work productivity appears to be having a dramatic impact on patient satisfaction and disease control.

"Technology helps patients with chronic disease feel informed and empowered," says Daniel Hommes, MD, director of the UCLA Center for Inflammatory Bowel Diseases. "We see a tremendous feeling of satisfaction in our patients,a sense of being in control. And because patients are doing a great job entering data that are important for the monitoring of their disease, physicians love this approach too. As the U.S. healthcare system moves toward a greater emphasis of quality outcomes and cost control, technology can make a huge difference."

Dr. Hommes believes his center's approach, which employs iPads, smart phones and other home devices, can serve as a model for the management of other chronic diseases.

Technology at the Center for Inflammortory Bowel DiseasesThe traditional approach to assisting patients with IBD has left much to be desired, Dr. Hommes says, so the UCLA center is implementing a new approach in which it tracks each patient's value quotient (VQ) - a disease-specific data model that incorporates the annual burden of the patient's disease (including factors such as disease activity, complications, medication side effects and hospitalizations); quality of life; and work productivity. Each year, an individual patient's VQ is analyzed by the center's professional staff to determine factors that influence the score and to devise a plan for the year ahead. "It is our mission to annually improve each individual VQ," Dr. Hommes explains.

Efforts to raise patients' VQs are based on a tight control (TC) infrastructure integrating state-of-the-art healthcare delivery with translational research. The TC system for IBD care consists of well-defined care scenarios and clinical management based on the most up-to-date IBD practice guidelines. "This aims to make IBD care proactive rather than reactive," Dr. Hommes says.

A cornerstone of this strategy is the active participation of the patients in their own prevention-oriented care through technology. Patients are invited to enroll in four online programs:

  • My Academy, a personalized online teaching program that educates patients on the disease, treatments, home care and their individual care pathways;
  • My Work, which provides an in-depth analysisof the patient's work ability given his or her condition, as well as assistance in finding a profession that fits them best;
  • My Coach, a mental reinforcement programthat addresses patients' feelings of concern, isolation or depression related to their disease by helping to show the way to professional support; and
  • Biobank, in which patients can contribute tissue and blood samples to assist UCLA researchers in using advanced technology to identify disease and risk profiles for complications and drug side effects, as well as new treatments.

With the use of current personal communication devices (provided as loans for those who don't have their own), patients operate an easy-to-use program to transmit information on disease activity, quality of life and work productivity, as well as laboratory data to ensure tight monitoring of their disease. Created with substantial patient input and featuring attractive user interfaces, the secure Web-based program also serves as a one-stop source for everything from setting appointments to checking on real-time traffic around UCLA.

UCLA Center for Inflammatory Bowel Diseases' use of technology for patient education and monitoringMost important are the monitoring tools, driven by validated home-care indexes for disease activity. Patients with active disease are asked to input values every two weeks for a period of six weeks, those whose disease is in remission every two months. Different tight control scenarios are offered depending on the patient's disease activity and are organized around the medications needed and the required monitoring. Based on patients' inputs, their care is constantly fine-tuned. When patients are concerned about symptoms, a self-administered questionnaire helps to guide them. Meanwhile, any registered dip in the patient's VQ based on abnormal inputs or patient complaints alerts the clinical team, and the collected data guides the team to additional steps, which can include an e-consult or change in medication.

"Many patients with chronic disease are anxious and depressed - not because of the disease per se, but because of what they don't know," says Dr. Hommes. "They don't know what to expect, how to organize their lives, how to deal with their loved ones and engage socially. Helping patients become informed, active participants in their care makes a big difference for these individuals."

Equally important, Dr. Hommes notes, is the ability of technology to address issues of cost and quality. "Seventy percent of U.S. healthcare expenditures are related to chronic diseases," he says. "Providing better, more cost-effective management of these diseases requires smart monitoring, and that can't be done in hospitals. Embracing all that technology offers can help us to deliver better organized care by capturing data and turning it into information and decision support for doctors to direct patients in the best care."

For more information about the UCLA Center for Inflammatory Bowel Diseases' use of technology for patient education and monitoring, go to: www.gastro.ucla.edu/ibd





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