A personalised program to increase resilience in patients with inflammatory bowel disease (IBD) can substantially reduce hospitalisations and emergency room visits, according to a study by Mount Sinai researchers presented at the annual scientific meeting of the American College of Gastroenterology (ACG 2020).
The researchers, led by Principal Investigator, Dr Laurie Keefer, Professor of Medicine (Gastroenterology) and Psychiatry, Icahn School of Medicine at Mount Sinai, and inventor of the GRITT (Gaining Resilience Through Transitions) methodology, said the programme builds on the principles of positive psychology, which focuses on how people flourish despite obstacles and supports patients to achieve six key outcomes: optimism, disease acceptance, self-regulation skills, self-efficacy, social support and resilience.
In a previous study, "High Levels of Psychological Resilience Associated With Less Disease Activity, Better Quality of Life, and Fewer Surgeries in Inflammatory Bowel Disease," published in July 2020 in Inflammatory Bowel Disease, Keefer's team reported for the first time that low resilience was tied to worse IBD outcomes, including low quality of life, higher disease activity, and higher rates of surgery for Crohn's disease.
The current study included 336 patients, who were selected based on their ‘GRITT Score’, an algorithm developed by the researchers to measure resilience in multiple areas including disease management skills, social support, physical symptom experience, psychological symptom experience and nutritional status.
Of the study group, 126 patients graduated from the program; the remaining 210 patients served as controls. Graduates of the programme experienced a 90 percent reduction in emergency department visits and an 88 percent reduction in hospitalisations, compared to no significant reductions in health care utilization in the control group at one-year follow up. Their GRITT Scores increased by an average of 33 points, demonstrating improved resilience.
"GRITT is about providing highly coordinated expert care that is both holistic and personalised,” added Keefer “A chronic condition like Crohn's can be all-encompassing and extremely onerous for the patient to manage alone. The GRITT philosophy is founded on the idea of connection and coordination to support the patient every step of the way.”
The GRITT approach gives low-resilience patients a personalised ‘playbook’ that is implemented by a team that includes social workers, dietitians, pharmacists and nurse specialists. Patients are deemed graduates upon reaching a set of established resilience targets.
"We are constantly monitoring our patients, particularly with an eye on life transitions that could impact self-management, such as college, pregnancy, or a job change,” said Keefer. “The pandemic has taken an unprecedented toll on patients, causing an uptick in stress, depression, anxiety, and sleep disturbances. We were thankful to have GRITT available as a source of support in an unusually difficult and uncertain time.”
"The study results we are sharing today underline what we see every day in the clinic at the Feinstein IBD Clinical Center: the extraordinary impact of a resilience-driven care coordination program on the lives of our patients. It is cutting-edge, evidence-based, and extremely patient friendly," added co-author, Dr Marla Dubinsky, Co-Director of the Susan and Leonard Feinstein IBD Clinical Center at Mount Sinai Hospital, and Professor of Pediatrics (Pediatric Gastroenterology), and Medicine (Gastroenterology), at the Icahn School of Medicine at Mount Sinai.