Background & Aims

Integrated inflammatory bowel disease (IBD) care is effective but not routinely implemented. Validated methods that simultaneously address mind and body targets such as resilience may improve access and outcomes. We describe the development and implementation of the GRITT method and its impact on resilience, health care utilization (HCU), and opioid use in IBD.

Methods

Consecutive patients from an academic IBD center were evaluated for low resilience on the basis of provider referral. Low resilience patients were invited to participate in the GRITT program. Primary outcome was % reduction in HCU. Secondary outcomes were change in resilience and corticosteroid and opioid use. Patients were allocated into 2 groups for analysis: GRITT participants (GP) and non-participants (NP). Clinical data and HCU in the year before enrollment were collected at baseline and 12 months. One-way repeated measures multivariate analysis of covariance evaluated group × time interactions for the primary outcome. Effect size was calculated for changes in resilience over time.

Results

Of 456 screened IBD patients 394 were eligible, 184 GP and 210 NP. GP had greater reduction in HCU than NP: 71% reduction in emergency department visits, 94% reduction in unplanned hospitalizations. There was 49% reduction in opioid use and 73% reduction in corticosteroid use in GP. Resilience increased by 27.3 points (59%), yielding a large effect size (d = 2.4).

Conclusions

Mind-body care that focuses on building resilience in the context of IBD care may be a novel approach to reduce unplanned HCU and opioid use, but large, multicenter, randomized controlled trials are needed.

中文翻译：

---

基于弹性的综合 IBD 护理与减少医疗保健使用和阿片类药物有关

背景与目标

综合炎症性肠病 (IBD) 护理是有效的，但并未常规实施。同时解决心理和身体目标（如复原力）的经过验证的方法可能会改善访问和结果。我们描述了 GRITT 方法的开发和实施及其对 IBD 中恢复力、医疗保健利用 (HCU) 和阿片类药物使用的影响。

方法

在提供者转诊的基础上，对来自学术 IBD 中心的连续患者进行了低弹性评估。低复原力患者被邀请参加 GRITT 计划。主要结果是 HCU 减少百分比。次要结果是弹性和皮质类固醇和阿片类药物使用的变化。患者被分为两组进行分析：GRITT 参与者 (GP) 和非参与者 (NP)。在基线和 12 个月时收集入组前一年的临床数据和 HCU。对主要结果的协方差评估组×时间交互作用的单向重复测量多变量分析。计算弹性随时间变化的影响大小。

结果

在 456 名筛选的 IBD 患者中，394 名符合条件，184 名 GP 和 210 名 NP。与 NP 相比，GP 的 HCU 减少幅度更大：急诊就诊减少 71%，计划外住院减少 94%。GP 中阿片类药物的使用减少了 49%，皮质类固醇的使用减少了 73%。弹性增加了 27.3 个点 (59%)，产生了较大的效应量 (d = 2.4)。

结论

专注于在 IBD 护理背景下建立复原力的身心护理可能是一种减少计划外 HCU 和阿片类药物使用的新方法，但仍需要大型、多中心、随机对照试验。