Patient outcomes and healthcare utilisation following implementation of an advanced therapy care pathway for inflammatory bowel disease: a multicentre, prospective quasi-experimental preimplementation/postimplementation study in the Netherlands

Abstract

Abstract Objective Care pathways have the potential to decrease treatment variation and improve patient outcomes. This study aims to evaluate the effect of an advanced therapy care pathway (ACP) on patient outcomes, healthcare utilisation and treatment variation among patients with inflammatory bowel disease (IBD) in the Netherlands. Methods A multicentre, prospective quasi-experimental preimplementation/postimplementation study was conducted, with a preimplementation (December 2020–December 2021) and postimplementation period (March 2022–March 2023). Outcomes were collected from electronic medical records and validated questionnaires according to the International Consortium for Health Outcomes Measurement standard set. The effect of the ACP was analysed using difference-in-differences (DiD) analysis. Results 1173 patients were included; the majority was female (55%) with a median age of 45 years (IQR 33–58 years). Most patients had Crohn’s disease (64%). Patients reported a high level of disease control and this did not change postimplementation (DiD-estimate: 0.12, 95% CI −0.74 to 1.01). Number of emergency room visits and hospital admissions decreased significantly 6 months postimplementation; however, the effect attributable to the ACP was only maintained for admissions (DiD-estimate visits: −0.05, 95% CI −0.10 to 0.01; DiD-estimate admissions: −0.06, 95% CI −0.11 to −0.03). Conclusion Implementation of an ACP, in which a minimum of care is defined, can achieve outcomes comparable to standard practice, highlighting the value of prioritising structured care pathways, especially given the current burden of IBD on healthcare systems. An ACP can guide healthcare providers and policymakers in standardising treatment and improving quality of care in chronic disease management. Study registration NL8276/NL-OMON21751 (https://onderzoekmetmensen.nl/en/trial/21751).