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Navigation needed to bridge Medicaid, IBD care engagement
Patients with inflammatory bowel disease who are covered by Medicaid are more likely to experience hospitalizations and emergency department visits than other patients, according to study results.
Rajani Sharma, MD, of the division of digestive and liver diseases at Columbia University Medical Center, and colleagues wrote that while it helps lower costs and other socioeconomically driven aspects of health care, patients with Medicaid are at risk for decreased engagement in their care due to factors like underinsurance and inconsistent access.
“Despite the relationship between Medicaid, health care utilization, and poor health outcomes in other disease states, there is a substantial lack of data regarding insurance status and IBD care, with only a few small studies demonstrating conflicting data,” they wrote.
Researchers identified adult patients with IBD who took part in colorectal cancer surveillance colonoscopy program between 2007 and 2017 to determine if Medicaid was a predictor for IBD care and outcomes, including inpatient hospitalizations, emergency department visits and steroid exposure. Of 947 patients, 221 (23%) had ever been enrolled in Medicaid.
Compared with patients with other insurance, patients with Medicaid had higher rates of hospital admission (77.6% vs. 42.6%; P < .0001) and emergency department visits (90.5% vs. 38.4%; P < .0001). Patients with Medicaid also had higher prevalence of requiring steroids (62.4% vs. 37.7%; P < .0001).
After adjusting for sex, age at first colonoscopy and ethnicity, researchers found that patients with Medicaid still had a higher rate of inpatient hospitalizations (RR = 2.95; 95% CI, 2.59–3.36) and emergency department visits (RR = 4.24; 95% CI, 3.82–4.7). Adjusting for these factors also increased the odds of patients with Medicaid needing steroids (OR = 3.77; 95% CI, 2.53–5.62).
Sharma and colleagues wrote that their findings show the need to update current health care models in ways that help improve patient engagement.
“Studies show that improving social support systems for patients and creating chronic care models that include patient and provider-oriented education, care management, and information system changes have had the most success in improving the care of chronically ill patients,” they concluded. “In particular, case management to assist patients in navigating the health care system has shown benefits in improving care, and it could be used to address disparities in this IBD population.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.