Inflammatory Bowel Disease Population Analyzer Tool for Health Systems (IBD PATH): a case study risk stratifying patients with inflammatory bowel disease for clinical outcomes

Inflammatory bowel disease (IBD) imposes a significant economic burden and highlights healthcare disparities. To enhance patient outcomes, reduce costs, and address care disparities, population health management (PHM) strategies, including race/ethnicity stratification, are employed. This case study was conducted at Ochsner Health (Ochsner) using an IBD Population Analyzer Tool for Health Systems (IBD PATH) to identify data standardization gaps and support PHM. Ochsner extracted medical records data for patients with IBD visits occurring between January 2020 and December 2021. Risk stratification was based on specific criteria outlined in the American Gastroenterology Association (AGA) risk factors for poor outcomes in Crohn's disease (CD) and ulcerative colitis (UC). The data was formatted per the tool specifications then subsequently uploaded into IBD PATH and descriptively analyzed by the tool. A total of 124 patients with CD and 71 patients with UC were included in the analysis. Most cases (82% CD, 77% UC) were classified as moderate/high risk. Over 85% of Black patients with CD/UC were at moderate/high risk while approximately 75% of White patients with CD/UC were at moderate/high risk. While 30% of patients at moderate/high risk had a biologic medication order, nearly 50% did not have an IBD medication order in the data timeframe. For CD, 86% of Black patients and 80% of White patients were noted to have moderate/high risk disease. This study highlights IBD PATH's capability in identifying population-level care gaps, emphasizing the need for comprehensive data for robust conclusions and interventions in PHM efforts. Results are dependent on data completeness.