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BACKGROUND Although previous studies have shown that participating in a structured national quality improvement program improves healthcare utilization for patients with inflammatory bowel disease (IBD), it is not known whether the extent of active participation influences health outcomes. Patients in the IBD Qorus Learning Health System self-report symptoms and treatment goals prior to clinic visits via electronic surveys, which facilitates disease surveillance and patient-provider co-production of care. This study assesses the relationship between active patient participation and IBD-related healthcare utilization outcomes. METHODS We reviewed electronic health records and surveys of patients with IBD from a private community gastrointestinal practice participating in Qorus for two years after they submitted the first pre-clinic survey. The study period was from 2016 to 2021. Primary outcomes were times from the first survey to an IBD-related ED visit/hospitalization, urgent message*, and CT-scan use. Participation score was calculated as a ratio of eligible surveys (submitted within two weeks prior to clinic visits) to the number of clinic visits, with a ratio RESULTS Out of 244 patients, 122 were inactive participants and 122 were active participants. Among inactive participants, 23.8% experienced an IBD-related ED visit/hospitalization, 27.9% sent an urgent message, and 12.3% received a CT scan. Among active participants, 18.9 % experienced an IBD-related ED visit/hospitalization, 21.3% sent an urgent message, and 12.3% received a CT scan (Table 1). Active and inactive (reference) Qorus participants were not statistically different in their healthcare utilization: ED visit/hospitalization (HR 0.61[95% CI 0.34-1.09]), sending an urgent message (HR 0.68 [95% CI 0.40-1.15]), and CT scan use (HR 1.00 [95% CI 0.47-2.13]), after adjusting for confounders (Table 2). CONCLUSION Although active participants show numerically less frequent ED visit/hospitalization and urgent message than inactive participants, there was not a statistically significant association between participation and healthcare utilization. A greater sample size is needed to draw further conclusions to inform future strategies to engage patients and optimize health outcomes.

BACKGROUND Patient-provider co-production of care is integral to managing inflammatory bowel diseases (IBD), chronic and incurable conditions that affect patients’ quality of life. Patients in the IBD Qorus Learning Health System self-report symptoms and treatment goals prior to clinic visits via electronic surveys, which helps their providers develop patient-centered treatment plans. This study examines factors that predict patients’ active participation in the program to inform future strategies to promote programmatic engagement and continuity of care. METHODS A retrospective cohort study was performed using electronic health records and survey results from a private community gastrointestinal practice engaged with Qorus between 2016 and 2021. Patients with IBD who consented to participate in Qorus were followed for two years after they submitted the first pre-clinic visit survey. The primary outcome was the ratio of eligible surveys (submitted within two weeks prior to clinic visits) to the number of clinic visits, with a ratio RESULTS Among 244 patients who met the inclusion criteria, 122 were inactive participants and 122 were active participants. Inactive participants completed a median of 0 (IQR 0-1) surveys and 3 (IQR 1-5) clinic visits, while active participants completed a median of 2 (IQR 1-3) surveys and 2 (IQR 2-4) clinic visits (Table 1). Multivariable logistics regression shows that older age, history of anxiety or depression, and higher number of clinic visits were associated with inactive participation. Compared to the age group 18-24 years old, patients ≥35 were less likely to participate actively: 35-44 (OR 0.32 [95% CI 0.11-0.90]), 45-54 (OR 0.24 [95% CI 0.07-0.72]), ≥55 (OR 0.34 [95% CI 0.12-0.94]). Patients with a history of anxiety or depression showed less active participation than those without (OR 0.44 [95% CI 0.25-0.77]). Higher number of clinic visits was also associated with less active participation (OR 0.88 [95% CI 0.78-0.99]) (Table 2). CONCLUSION Age ≥35, history of anxiety or depression, and frequent clinic visits were associated with less active participation in an IBD Learning Health System. Lack of familiarity with digital health resources, concomitant mental health disorders, or participation fatigue may potentially explain these findings. Further research is needed to investigate the causes of inactive participation to design interventions that address these causes.

INTRODUCTION In a biopsychosocial interdisciplinary model, complex interactions between the hosts (individuals/patients), disease (e.g., ulcerative colitis [UC]), and environment (e.g., social determinants of health [SDOH]) may all contribute to the disease burden. Whether SDOH contributes to the symptomatic burden of UC in deep remission is unclear. METHODS We performed a secondary analysis on prospectively collected data from adults with UC enrolled in the biobank at a tertiary referral center in southern California from 2014-2021. Standardized clinical (unweighted two-item patient-reported outcome [PRO-2] for stool frequency [SF] and rectal bleeding [RB]; remission=SF0/RB0), endoscopic (Ulcerative Colitis Endoscopic Index of Severity [UCEIS]; remission UCEIS=0), and histologic (Geboes score; remission We used χ2-square and Wilcoxon-Mann Whitney tests to investigate for associations between SDOH factors (non-parametric, independent variables dichotomized as below vs above the median) and cardinal GI symptoms (continuous unweighted PRO-2 symptomatic severity and dichotomized clinical remission/active disease), patient-, and disease-related factors. In adults with UC in endoscopic or endo-histologic remission, we used univariate logistic regression to assess the risk of health disadvantage (SDOH score below median) and the presence of GI symptoms. RESULTS Of the 166 UC cases, 46% (76/166), 38% (63/166), and 30% (49/166) were in clinical, endoscopic, and endo-histologic remission, respectively. Approximately one-fifth of cases (21%, 35/166) had SDOH scores below the state median. However, health disadvantage (below SDOH index median) was not associated with clinical, endoscopic, or endo-histologic disease activity; and neither were IBD duration; gender or race/ethnicity (all p>0.05) (Tab 1). Approximately one-third of cases had active GI symptoms despite endoscopic (32%, 20/63) and endo-histologic remission (29%, 14/49). However, none of the eight investigated SDOH domains were associated with increased risks for GI symptoms when UC had objective mucosal healing on colonoscopy (Tab 2) CONCLUSION Although one-third of adults with mucosal healing of UC report GI symptoms (diarrhea/rectal bleeding), there was no association with multiple social determinants of health factors (e.g., education, neighborhood, economic, social, and environmental) in this secondary analysis of a prospective cohort.

BACKGROUND Social factors such as race, education, and financial hardships have been shown to affect health outcomes of patients with inflammatory bowel disease (IBD). Although early identification of socially vulnerable patients is critical for targeted interventions, it is still limited by screening tools that are incomprehensive and time-consuming. We investigate the utility of the social vulnerability index (SVI), a census tract-specific measure estimated by the Centers for Disease Control and Prevention, for predicting patients' healthcare utilization, based on 15 different social determinant variables including employment, housing, and transportation. METHODS We reviewed the electronic health records and surveys of patients with IBD at a private community practice enrolled in IBD Qorus Learning Health System, a national quality improvement consortium, from 2016-2021. Each patient's home address was mapped to an SVI value, ranging from 0 to 1 and increasing as the patient's vulnerability increased. An SVI was considered low if it was less than the median SVI and high if it was greater than or equal to the median SVI. Cox proportional hazards regression was performed to determine the relationship between SVI and healthcare utilization (IBD-related ED visit/hospitalization, urgent message*, and CT scan use), controlling for potential confounders such as IBD subtype, baseline clinical disease activity, physician global assessment, steroid use, and six-months-prior IBD-related ED visit/hospitalization and CT scan use. The “survival time” was defined as the time from when the patient first joined the program to IBD-related healthcare utilization events, loss of follow-up in the electronic health records, or the end of the study period, whichever occurred earliest. RESULTS Among 280 eligible patients, the median SVI was 0.288 (IQR 0.121-0.433) (Figure 1). Among the low SVI group, 16.4% experienced an IBD-related ED visit/hospitalization, 20.0% sent an urgent message, and 10.0% received a CT scan. Among the high SVI group, 23.6% experienced an IBD-related ED visit/hospitalization, 26.4% sent an urgent message, and 12.9% received a CT scan. High and low SVI groups (reference) were not significantly different in their healthcare utilization: ED visit/hospitalization (HR 1.66 [95% CI 0.96-2.89]), sending an urgent message (HR 1.62 [95% CI 0.94-2.70]), and CT scan use (HR 2.31 [95% CI 0.98-5.47]), after adjusting for confounders (Table 1). CONCLUSION IBD-related healthcare utilization was not associated with social vulnerability at the census tract level in this cohort. The lack of statistical significance was likely due to the cohort’s low sample size and lack of demographic variability (92% white and 96.8% non-Hispanic). Additional research with a larger and more diverse sample may help clarify the association between SVI and outcomes.

Visceral hypersensitivity and low-grade mucosal inflammation are frequently observed in a subpopulation of patients with irritable bowel syndrome (IBS). The responsible mechanism is unclear. Resolvins are a novel class of anti-inflammatory lipid mediators that regulate resolution of inflammation and pain. We hypothesize that resolvin D1 (RvD1) synthesis is reduced in IBS with diarrhea (IBS-D) colonic mucosa and contributes to the development of visceral hypersensitivity.We used enzyme-linked immunosorbent assay and quantitative polymerase chain reaction to quantify the levels of RvD1 synthesis and the gene expression of LOX5 and LOX12 in colonic biopsy samples from healthy individuals (HC) or patients with IBS-D. To evaluate the role of gut bacteria in regulating RvD1 synthesis, we colonized germ-free mice with different strains of bacteria, fecal microbiota from HC individuals or patients with IBS-D. To evaluate the role of tuft cells in RvD1 synthesis, we examined the effect of fecal supernatant of IBS-D or HC subjects on human colonoids as well as colonoids from mice in which Chat-cre recombinase vector was used to knock in diphtheria toxin sensitive receptor (DTRWe report that colonic biopsy samples from patients with IBS-D generated significantly lower levels of RvD1 and LOX5 messenger RNA. The conventionalization of germ-free mice with microbiota from patients with IBS-D or gram-negative bacteria inhibited RvD1 biosynthesis and caused visceral hypersensitivity and mucosal inflammation. Colonic organoid studies demonstrate that Lps downregulated Lox5 messenger RNA expression and synthesis of RvD1 via Tlr4-MyD88 receptor signaling pathway in colonic tuft cells.Our findings indicate that RvD1 is generated in colonic tuft cells to regulate gut sensitivity to mechanical stimulation. Colonic commensal bacterial composition regulates the synthesis of RvD1 in colonic mucosa, which is reduced in patients with IBS-D. This appears to be mediated by elevated fecal lipopolysaccharide secondary to gram-negative gut dysbiosis.