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Multicenter Study
. 2025 Feb 6;31(2):332-343.
doi: 10.1093/ibd/izae095.

Variation Between Hospitals in Outcomes and Costs of IBD Care: Results From the IBD Value Study

Reinier C A van Linschoten  1   2 , C Janneke van der Woude  2 , Elyke Visser  1   2 , Nikki van Leeuwen  3 , Alexander G L Bodelier  4 , Claire Fitzpatrick  5 , Vincent de Jonge  6 , Hestia Vermeulen  7 , K Evelyne Verweij  8 , Sanne van der Wiel  9 , Daan Nieboer  3 , Erwin Birnie  10   11 , Daniëlle van der Horst  12 , Jan A Hazelzet  3 , Desirée van Noord  1 , Rachel L West  1
Affiliations
Multicenter Study

Variation Between Hospitals in Outcomes and Costs of IBD Care: Results From the IBD Value Study

Reinier C A van Linschoten et al. Inflamm Bowel Dis. .

Abstract

Background: Data on variation in outcomes and costs of the treatment of inflammatory bowel disease (IBD) can be used to identify areas for cost and quality improvement. It can also help healthcare providers learn from each other and strive for equity in care. We aimed to assess the variation in outcomes and costs of IBD care between hospitals.

Methods: We conducted a 12-month cohort study in 8 hospitals in the Netherlands. Patients with IBD who were treated with biologics and new small molecules were included. The percentage of variation in outcomes (following the International Consortium for Health Outcomes Measurement standard set) and costs attributable to the treating hospital were analyzed with intraclass correlation coefficients (ICCs) from case mix-adjusted (generalized) linear mixed models.

Results: We included 1010 patients (median age 45 years, 55% female). Clinicians reported high remission rates (83%), while patient-reported rates were lower (40%). During the 12-month follow-up, 5.2% of patients used prednisolone for more than 3 months. Hospital costs (outpatient, inpatient, and medication costs) were substantial (median: €8323 per 6 months), mainly attributed to advanced therapies (€6611). Most of the variation in outcomes and costs among patients could not be attributed to the treating hospitals, with ICCs typically between 0% and 2%. Instead, patient-level characteristics, often with ICCs above 50%, accounted for these variations.

Conclusions: Variation in outcomes and costs cannot be used to differentiate between hospitals for quality of care. Future quality improvement initiatives should look at differences in structure and process measures of care and implement patient-level interventions to improve quality of IBD care.

Trial registration number: NL8276.

Keywords: advanced therapy; inflammatory bowel disease; quality improvement; value-based healthcare; variation.

Plain language summary

Variation in outcomes and costs cannot be used to differentiate between hospitals for quality of inflammatory bowel disease care. Future quality improvement initiatives should look at differences in structure and process measures and implement patient-level interventions to improve quality of inflammatory bowel disease care.

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Figures

Figure 1.
Figure 1.
Flow chart of patient inclusion. IBD, inflammatory bowel disease; m, months.
See this image and copyright information in PMC

References

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