Mitigating Disparities in Inflammatory Bowel Disease

Thomas Curran, M.D. and Erin Forster, M.D., MPH
Thomas Curran, M.D., and Erin Forster, M.D., MPH

Crohn’s disease and ulcerative colitis, also known as inflammatory bowel disease (IBD), affect millions of Americans and can significantly impair patient quality of life. Due to the complex nature of the disease, treatment can be challenging and requires a team with a deep understanding of IBD and its physical, medical, and emotional impact.

To address the specific needs of the IBD population, the MUSC Division of Gastroenterology and Hepatology is instituting a new model of care for patients with IBD: the IBD medical home.

Under the leadership of Erin Forster, M.D., MPH, Marvin Jenkins Family Endowed Chair for IBD, this new IBD medical home will offer patients complete treatment for digestive disorders, including seamless access to IBD experts from multiple specialties including surgeons, behavioral health experts, social workers, nurse practitioners, dietitians and others with the compassion and experience to care for people with IBD.

While there is no cure for IBD, modern medicine is rapidly evolving to give patients the highest quality of life. Unfortunately, the lack of access to subspecialists and multidisciplinary care creates disparities in IBD outcomes, especially for patients living in underserved areas.

One priority in establishing the new IBD medical home at MUSC is to identify disparities in care and outcomes of patients with IBD to improve health care equity and delivery.

Dr. Forster teamed up with researcher and colorectal surgeon Thomas Curran, M.D., to examine the state of IBD care in South Carolina.

“As part of our collaboration with colorectal surgery, one of our first goals was to obtain a snapshot of inflammatory bowel disease patients in South Carolina,” said Dr. Forster. “We hope to be able to use our medical home to identify barriers and facilitators to improving care for all patients, but especially those that are particularly disadvantaged or under resourced.”

Existing evidence for disparities in IBD management is fragmented and heterogenous. In a recent study led by Dr. Curran, researchers performed a systematic review of the literature to examine disparities in surgery for inflammatory bowel disease in the United States. They discovered that not only do patients of color have limited representation in the literature, but also have worse outcomes. Dr. Curran and team also conducted an audit to determine the makeup of IBD patients at MUSC and the treatments they received.

“We have one of the largest proportions of African American patients in our state compared to the rest of the United States, and we have identified certain disparities in health care and access to surgery and surgical outcomes along racial lines,” said Dr. Forster.

In collaboration with investigators from Morehouse School of Medicine and the University of Mississippi, the MUSC IBD team is working to improve access and recruitment to patients of all colors to their research trials. Dr. Forster and colleagues recently received grant funding from the Patient-Centered Outcomes Research Institute (PCORI) to study “Engaging Inflammatory Bowel Disease Patients of Color in Patient-Centered Outcomes Research.” Julia Liu, M.D., at Morehouse School of Medicine is the primary investigator and Sarah Glover, D.O., from the University of Mississippi and Dr. Forster are co-investigators.

“MUSC has much to offer IBD patients throughout the state and to the academic environment more broadly, in terms of the representation of the patients that we have here and some of the lessons that we're in the process of learning of how best to navigate complex illness in the setting of social and structural determinants of health, that often, may be barriers,” said Dr. Curran. “We are thrilled to have this collaboration with the Department of Medicine and are uniquely positioned to really affect a lot of change for those patients who need it most who have inflammatory bowel disease.”