Trial Outcomes & Findings for Specialty Medical Homes to Improve Outcomes for Patients With IBD and Behavioral Health Conditions (NCT NCT03985800)

NCT ID: NCT03985800

Last Updated: 2025-09-03

Results Overview

IBD symptom severity was measured via a composite IBD Complexity Score developed by clinical researchers to quantify both biological and psychosocial domains of IBD within an SMH setting. It includes the sum of patient-reported responses to two scales: the PROMIS GI symptoms scale, evaluating four domains of gastrointestinal symptoms; and disease-specific PRO-2 disease severity indices taken from the Harvey Bradshaw Index (for individuals with Crohn's disease) and Ulcerative Colitis Activity Index (for individuals with ulcerative colitis). The complexity score is calculated by adding the value of the patient's PRO-2 to the cumulative PROMIS-GI score. Lower scores indicate lower symptom severity; higher scores indicate higher symptom severity. The minimum score is 0; the maximum score is open-ended based on patient response. Only the total IBD Complexity Score is reported.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

657 participants

Primary outcome timeframe

Compare scores at Baseline, 6-month and 12-month for any changes

Results posted on

2025-09-03

Participant Flow

Recruitment began on July 1, 2019 and was completed on February 28, 2024. A brief pause in recruitment occurred between March 13 and September 13, 2020 to account for disruptions related to the COVID-19 pandemic. All participants were recruited from one of three specialty medical home clinics at large urban academic centers in the northeastern US: UPMC in Pittsburgh, Mount Sinai Hospital in New York, and the Cleveland Clinic in Cleveland.

All participants were randomly assigned to one of the two intervention arms upon successful enrollment in the study. Allocation was stratified based on age (18-30 or 31-60), IBD diagnosis (Crohn's disease or ulcerative colitis) and disease activity (low or high).

Participant milestones

Participant milestones
Measure
TEAM
TEAM is a high-human touch, multidisciplinary specialty medical home approach that connects participants with a personalized care team including gastroenterologists, advanced practice providers, behavioral health specialists, dietitians, registered nurses, pharmacists, and health coordinators who provide intensive support and resources for patients.
TECH
TECH is a low-human touch approach leveraging behavioral digital tools - primarily a digital cognitive behavioral therapy mobile application with embedded health coaches - to deliver behavioral health care at the patient's convenience.
Overall Study
STARTED
329
328
Overall Study
COMPLETED
323
320
Overall Study
NOT COMPLETED
6
8

Reasons for withdrawal

Reasons for withdrawal
Measure
TEAM
TEAM is a high-human touch, multidisciplinary specialty medical home approach that connects participants with a personalized care team including gastroenterologists, advanced practice providers, behavioral health specialists, dietitians, registered nurses, pharmacists, and health coordinators who provide intensive support and resources for patients.
TECH
TECH is a low-human touch approach leveraging behavioral digital tools - primarily a digital cognitive behavioral therapy mobile application with embedded health coaches - to deliver behavioral health care at the patient's convenience.
Overall Study
Death
1
2
Overall Study
Withdrawal by Subject
3
6
Overall Study
Protocol Violation
2
0

Baseline Characteristics

Specialty Medical Homes to Improve Outcomes for Patients With IBD and Behavioral Health Conditions

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
TEAM
n=329 Participants
TEAM is a high-human touch, multidisciplinary specialty medical home approach that connects participants with a personalized care team including gastroenterologists, advanced practice providers, behavioral health specialists, dietitians, registered nurses, pharmacists, and health coordinators who provide intensive support and resources for patients.
TECH
n=328 Participants
TECH is a low-human touch approach leveraging behavioral digital tools - primarily RxWell, a digital cognitive behavioral therapy mobile application with embedded health coaches - to deliver behavioral health care at the patient's convenience.
Total
n=657 Participants
Total of all reporting groups
Sex/Gender, Customized
Gender · Female
211 Participants
n=5 Participants
213 Participants
n=7 Participants
424 Participants
n=5 Participants
Sex/Gender, Customized
Gender · Male
93 Participants
n=5 Participants
90 Participants
n=7 Participants
183 Participants
n=5 Participants
Sex/Gender, Customized
Gender · Other
2 Participants
n=5 Participants
1 Participants
n=7 Participants
3 Participants
n=5 Participants
Sex/Gender, Customized
Gender · Prefer not to answer
1 Participants
n=5 Participants
1 Participants
n=7 Participants
2 Participants
n=5 Participants
Sex/Gender, Customized
Gender · Missing
22 Participants
n=5 Participants
23 Participants
n=7 Participants
45 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
17 Participants
n=5 Participants
13 Participants
n=7 Participants
30 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
269 Participants
n=5 Participants
275 Participants
n=7 Participants
544 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
43 Participants
n=5 Participants
40 Participants
n=7 Participants
83 Participants
n=5 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Asian
6 Participants
n=5 Participants
3 Participants
n=7 Participants
9 Participants
n=5 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Black or African American
24 Participants
n=5 Participants
13 Participants
n=7 Participants
37 Participants
n=5 Participants
Race (NIH/OMB)
White
254 Participants
n=5 Participants
271 Participants
n=7 Participants
525 Participants
n=5 Participants
Race (NIH/OMB)
More than one race
5 Participants
n=5 Participants
11 Participants
n=7 Participants
16 Participants
n=5 Participants
Race (NIH/OMB)
Unknown or Not Reported
40 Participants
n=5 Participants
30 Participants
n=7 Participants
70 Participants
n=5 Participants
IBD Diagnosis
Crohn's disease
222 Participants
n=5 Participants
218 Participants
n=7 Participants
440 Participants
n=5 Participants
IBD Diagnosis
Ulcerative colitis
107 Participants
n=5 Participants
110 Participants
n=7 Participants
217 Participants
n=5 Participants
Steroid Use
Yes
121 Participants
n=5 Participants
119 Participants
n=7 Participants
240 Participants
n=5 Participants
Steroid Use
No
208 Participants
n=5 Participants
209 Participants
n=7 Participants
417 Participants
n=5 Participants
Opioid use
Yes
108 Participants
n=5 Participants
105 Participants
n=7 Participants
213 Participants
n=5 Participants
Opioid use
No
216 Participants
n=5 Participants
218 Participants
n=7 Participants
434 Participants
n=5 Participants
Opioid use
Missing
5 Participants
n=5 Participants
5 Participants
n=7 Participants
10 Participants
n=5 Participants
Advanced therapy
Yes
185 Participants
n=5 Participants
169 Participants
n=7 Participants
354 Participants
n=5 Participants
Advanced therapy
No
144 Participants
n=5 Participants
159 Participants
n=7 Participants
303 Participants
n=5 Participants
Comorbidity
Yes
147 Participants
n=5 Participants
143 Participants
n=7 Participants
290 Participants
n=5 Participants
Comorbidity
No
182 Participants
n=5 Participants
185 Participants
n=7 Participants
367 Participants
n=5 Participants
Age, Continuous
34.7 Years
STANDARD_DEVIATION 10.6 • n=5 Participants
34.9 Years
STANDARD_DEVIATION 10.8 • n=7 Participants
34.8 Years
STANDARD_DEVIATION 10.7 • n=5 Participants

PRIMARY outcome

Timeframe: Compare scores at Baseline, 6-month and 12-month for any changes

Population: Participants were included in the analysis for IBD Symptom Severity as long as they had complete covariate data and the IBD Complexity Score measured at at least one timepoint.

IBD symptom severity was measured via a composite IBD Complexity Score developed by clinical researchers to quantify both biological and psychosocial domains of IBD within an SMH setting. It includes the sum of patient-reported responses to two scales: the PROMIS GI symptoms scale, evaluating four domains of gastrointestinal symptoms; and disease-specific PRO-2 disease severity indices taken from the Harvey Bradshaw Index (for individuals with Crohn's disease) and Ulcerative Colitis Activity Index (for individuals with ulcerative colitis). The complexity score is calculated by adding the value of the patient's PRO-2 to the cumulative PROMIS-GI score. Lower scores indicate lower symptom severity; higher scores indicate higher symptom severity. The minimum score is 0; the maximum score is open-ended based on patient response. Only the total IBD Complexity Score is reported.

Outcome measures

Outcome measures
Measure
TEAM
n=329 Participants
TEAM is a high-human touch, multidisciplinary specialty medical home approach that connects participants with a personalized care team including gastroenterologists, advanced practice providers, behavioral health specialists, dietitians, registered nurses, pharmacists, and health coordinators who provide intensive support and resources for patients.
TECH
n=328 Participants
TECH is a low-human touch approach leveraging behavioral digital tools - primarily RxWell, a digital cognitive behavioral therapy mobile application with embedded health coaches - to deliver behavioral health care at the patient's convenience.
IBD Symptom Severity
Score at baseline
75.9 Score on a scale
Standard Deviation 31.0
79.9 Score on a scale
Standard Deviation 31.3
IBD Symptom Severity
Score at 6-month follow-up
63.5 Score on a scale
Standard Deviation 30.0
65.0 Score on a scale
Standard Deviation 33.2
IBD Symptom Severity
Score at 12-month follow-up
62.3 Score on a scale
Standard Deviation 31.2
64.4 Score on a scale
Standard Deviation 32.2

PRIMARY outcome

Timeframe: Compare at Baseline, 6-month and 12-month for any changes

Behavioral health symptom severity was measured utilizing the Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS) - which combines the PHQ-8 and GAD-7 scales - as a composite measure of depression and anxiety. The Patient Health Questionnaire 8-item depression scale (PHQ-8) and 7-item Generalized Anxiety Disorder scale (GAD-7) are among the best validated and most commonly used depression and anxiety measures, respectively. The PHQ-ADS is the sum of the PHQ-8 and GAD-7, where a decrease in scores indicates a decrease in BH symptom severity; a decrease of 3-4 points indicates MCID. Lower scores indicate lower levels of behavioral health symptom severity; higher scores indicate higher symptom severity. The minimum score is 0; the maximum score is 45. Only the total PHQ-ADS is reported.

Outcome measures

Outcome measures
Measure
TEAM
n=329 Participants
TEAM is a high-human touch, multidisciplinary specialty medical home approach that connects participants with a personalized care team including gastroenterologists, advanced practice providers, behavioral health specialists, dietitians, registered nurses, pharmacists, and health coordinators who provide intensive support and resources for patients.
TECH
n=328 Participants
TECH is a low-human touch approach leveraging behavioral digital tools - primarily RxWell, a digital cognitive behavioral therapy mobile application with embedded health coaches - to deliver behavioral health care at the patient's convenience.
Behavioral Health Symptom Severity
Score at baseline
25.4 Score on a scale
Standard Deviation 7.88
26.2 Score on a scale
Standard Deviation 7.94
Behavioral Health Symptom Severity
Score at 6-month follow-up
18.7 Score on a scale
Standard Deviation 10.9
19.7 Score on a scale
Standard Deviation 10.9
Behavioral Health Symptom Severity
Score at 12-month follow-up
18.0 Score on a scale
Standard Deviation 11.2
19.2 Score on a scale
Standard Deviation 11.5

SECONDARY outcome

Timeframe: Compare at baseline, 6-month and 12-month for any changes

Functional impairment was measured using the validated Short Form 12 Health Survey Version 2 (SF-12v2) which includes 12 items from the Short-Form 36 Health Survey and yields a physical and mental composite score as well as 8 subscale values: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Responses are tallied via a norm-based scoring algorithm provided by the assessment licensing company. Lower scores correspond with poorer health-related functioning; higher scores indicate better health-related functioning. The minimum score is 18.5; the maximum score is 142.6. Only the total composite score (the sum of both the physical and mental scales) is reported.

Outcome measures

Outcome measures
Measure
TEAM
n=329 Participants
TEAM is a high-human touch, multidisciplinary specialty medical home approach that connects participants with a personalized care team including gastroenterologists, advanced practice providers, behavioral health specialists, dietitians, registered nurses, pharmacists, and health coordinators who provide intensive support and resources for patients.
TECH
n=328 Participants
TECH is a low-human touch approach leveraging behavioral digital tools - primarily RxWell, a digital cognitive behavioral therapy mobile application with embedded health coaches - to deliver behavioral health care at the patient's convenience.
Functional Impairment
Score at baseline
37.6 Score on a scale
Standard Deviation 6.57
38.4 Score on a scale
Standard Deviation 6.36
Functional Impairment
Score at 6-month follow-up
34.2 Score on a scale
Standard Deviation 7.98
34.7 Score on a scale
Standard Deviation 7.58
Functional Impairment
Score at 12-month follow-up
33.3 Score on a scale
Standard Deviation 7.70
33.5 Score on a scale
Standard Deviation 8.07

SECONDARY outcome

Timeframe: Compare at baseline, 6-month and 12-month for any changes

IBD-IBS Symptom Severity was measured using the Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS) to more accurately capture IBD symptom severity for many individuals with IBD, particularly those with inactive IBD but persistent functional GI symptoms (e.g., IBD-IBS). The IBS-SSS scores pain severity, pain frequency, abdominal bloating, bowel satisfaction and interference with life on a 0-100 scale with a total score of 500. A 50-point or more reduction in this score is considered clinically meaningful. Total scores range from 0 to 500 with higher scores indicating more severe symptoms. Answers to all questions are summed to achieve the total score. Subjects can be categorized as having mild (75-175), moderate (175-300), or severe (\>300) IBS. Only total scores are reported.

Outcome measures

Outcome measures
Measure
TEAM
n=329 Participants
TEAM is a high-human touch, multidisciplinary specialty medical home approach that connects participants with a personalized care team including gastroenterologists, advanced practice providers, behavioral health specialists, dietitians, registered nurses, pharmacists, and health coordinators who provide intensive support and resources for patients.
TECH
n=328 Participants
TECH is a low-human touch approach leveraging behavioral digital tools - primarily RxWell, a digital cognitive behavioral therapy mobile application with embedded health coaches - to deliver behavioral health care at the patient's convenience.
IBD-IBS Symptom Severity
Score at baseline
222 Score on a scale
Standard Deviation 135
238 Score on a scale
Standard Deviation 130
IBD-IBS Symptom Severity
Score at 6-month follow-up
185 Score on a scale
Standard Deviation 125
175 Score on a scale
Standard Deviation 123
IBD-IBS Symptom Severity
Score at 12-month follow-up
174 Score on a scale
Standard Deviation 124
179 Score on a scale
Standard Deviation 125

SECONDARY outcome

Timeframe: Compare at baseline, 6-month and 12-months for any changes

Health care utilization was captured through EHR data to measure categorical (yes or no) instances of ED visits and inpatient hospitalizations at both 6- and 12-months post-enrollment.

Outcome measures

Outcome measures
Measure
TEAM
n=329 Participants
TEAM is a high-human touch, multidisciplinary specialty medical home approach that connects participants with a personalized care team including gastroenterologists, advanced practice providers, behavioral health specialists, dietitians, registered nurses, pharmacists, and health coordinators who provide intensive support and resources for patients.
TECH
n=328 Participants
TECH is a low-human touch approach leveraging behavioral digital tools - primarily RxWell, a digital cognitive behavioral therapy mobile application with embedded health coaches - to deliver behavioral health care at the patient's convenience.
Health Care Utilization
Hospitalizations · Yes
35 Participants
36 Participants
Health Care Utilization
Hospitalizations · No
292 Participants
291 Participants
Health Care Utilization
Hospitalizations · Missing
2 Participants
1 Participants
Health Care Utilization
ED Visits · Yes
27 Participants
31 Participants
Health Care Utilization
ED Visits · No
297 Participants
297 Participants
Health Care Utilization
ED Visits · Missing
5 Participants
0 Participants

SECONDARY outcome

Timeframe: Compare at baseline, 6-month and 12-month for any changes

Patient engagement was measured using the validated IBD Self-Efficacy Scale (IBD-SES) which assesses one's confidence level in managing stress and emotions, managing medical care, managing symptoms and disease, and maintaining remission. The IBD-SES measures self-management activities across four subscales (Stress and Emotions; Medical Care; Symptoms and Disease; Remission), with higher scores indicating greater confidence in self-management. Responses for each question are summed to produce one overall and four subscale scores. The total score range is between 29 and 290, with 29 indicating the lowest level of self-efficacy and 290 indicating the highest. Each item is scored 1-10, with 1 being assigned for responses of "Not confident at all" and a score of 10 assigned for responses of "Totally confident." Only total scores are reported.

Outcome measures

Outcome measures
Measure
TEAM
n=329 Participants
TEAM is a high-human touch, multidisciplinary specialty medical home approach that connects participants with a personalized care team including gastroenterologists, advanced practice providers, behavioral health specialists, dietitians, registered nurses, pharmacists, and health coordinators who provide intensive support and resources for patients.
TECH
n=328 Participants
TECH is a low-human touch approach leveraging behavioral digital tools - primarily RxWell, a digital cognitive behavioral therapy mobile application with embedded health coaches - to deliver behavioral health care at the patient's convenience.
Patient Engagement
Score at baseline
161 Score on a scale
Standard Deviation 40
157 Score on a scale
Standard Deviation 35.8
Patient Engagement
Score at 6-month follow-up
174 Score on a scale
Standard Deviation 47.5
178 Score on a scale
Standard Deviation 46.9
Patient Engagement
Score at 12-month follow-up
178 Score on a scale
Standard Deviation 54.0
178 Score on a scale
Standard Deviation 49.7

SECONDARY outcome

Timeframe: Compare at baseline, 6-month and 12-month for any changes

Quality of life was evaluated using the Short Quality of Life in Inflammatory Bowel Disease Questionnaire (SIBDQ), a validated tool which measures physical, social, and emotional health-related quality of life (QOL) for patients with Crohn's disease and ulcerative colitis. On a 7-point scale, lower scores correspond with a lower perceived QOL, while higher scores represent a higher perceived QOL. Responses for each question are summed for a total score between 10 and 70, with 10 reflecting poor QOL and 70 reflecting high QOL. Each item is scored 1-7, with 1 being assigned for responses indicating the highest severity of symptoms, and 7 being assigned for those reflecting the lowest severity of symptoms. Only total scores are reported.

Outcome measures

Outcome measures
Measure
TEAM
n=329 Participants
TEAM is a high-human touch, multidisciplinary specialty medical home approach that connects participants with a personalized care team including gastroenterologists, advanced practice providers, behavioral health specialists, dietitians, registered nurses, pharmacists, and health coordinators who provide intensive support and resources for patients.
TECH
n=328 Participants
TECH is a low-human touch approach leveraging behavioral digital tools - primarily RxWell, a digital cognitive behavioral therapy mobile application with embedded health coaches - to deliver behavioral health care at the patient's convenience.
Quality of Life
Score at baseline
37.7 Score on a scale
Standard Deviation 10.7
35.5 Score on a scale
Standard Deviation 10.7
Quality of Life
Score at 6-month follow-up
42.6 Score on a scale
Standard Deviation 12.0
41.4 Score on a scale
Standard Deviation 11.9
Quality of Life
Score at 12-month follow-up
43.0 Score on a scale
Standard Deviation 12.5
43.4 Score on a scale
Standard Deviation 12.4

Adverse Events

TEAM

Serious events: 0 serious events
Other events: 0 other events
Deaths: 1 deaths

TECH

Serious events: 0 serious events
Other events: 0 other events
Deaths: 2 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Eva Szigethy, Co-Principal Investigator, Adjunct Professor of Psychiatry, Staff Psychiatrist

Department of Psychiatry, University of Pittsburgh

Phone: 412-667-0416

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place