Rachel Lawton, PhD

All Publications

• A Locally-Focused Structural Racism Curriculum for Pediatric Primary Care Residents. Academic pediatrics Sahai, A., Corley, A. M., Lipps, L., Lawton, R., DeBlasio, D., Klein, M. 2023; 23 (8): 1510-1512

  View details for DOI 10.1016/j.acap.2023.06.012

  View details for PubMedID 37302703

• "The Tough Get Going": Understanding the Role of Resilience and a Multidimensional Conceptualization of Mental Health Among Patients With Inflammatory Bowel Disease INFLAMMATORY BOWEL DISEASES Lawton, R. C. 2022; 28 (6): 977-979

  View details for DOI 10.1093/ibd/izab233

  View details for Web of Science ID 000756611200001

  View details for PubMedID 34534289

• Mental Health Costs of Inflammatory Bowel Diseases INFLAMMATORY BOWEL DISEASES Szigethy, E., Murphy, S. M., Ehrlich, O. G., Engel-Nitz, N. M., Heller, C. A., Henrichsen, K., Lawton, R., Meadows, P., Allen, J. 2021; 27 (1): 40-48

  Abstract

  Mental health diagnoses (MHDs) were identified as significant drivers of inflammatory bowel disease (IBD)-related costs in an analysis titled "Cost of Care Initiative" supported by the Crohn's & Colitis Foundation. In this subanalysis, we sought to characterize and compare IBD patients with and without MHDs based on insurance claims data in terms of demographic traits, medical utilization, and annualized costs of care.We analyzed the Optum Research Database of administrative claims from years 2007 to 2016 representing commercially insured and Medicare Advantage insured IBD patients in the United States. Inflammatory bowel disease patients with and without an MHD were compared in terms of demographics (age, gender, race), insurance type, IBD-related medical utilization (ambulatory visits, emergency department [ED] visits, and inpatient hospitalizations), and total IBD-related costs. Only patients with costs >$0 in each of the utilization categories were included in the cost estimates.Of the total IBD study cohort of 52,782 patients representing 179,314 person-years of data, 22,483 (42.6%) patients had at least 1 MHD coded in their claims data with a total of 46,510 person-years in which a patient had a coded MHD. The most commonly coded diagnostic categories were depressive disorders, anxiety disorders, adjustment disorders, substance use disorders, and bipolar and related disorders. Compared with patients without an MHD, a significantly greater percentage of IBD patients with MHDs were female (61.59% vs 48.63%), older than 75 years of age (9.59% vs 6.32%), white (73.80% vs 70.17%), and significantly less likely to be younger than 25 years of age (9.18% vs 11.39%) compared with those without mental illness (P < 0.001). Patients with MHDs had significantly more ED visits (14.34% vs 7.62%, P < 0.001) and inpatient stays (19.65% vs 8.63%, P < 0.001) compared with those without an MHD. Concomitantly, patients with MHDs had significantly higher ED costs ($970 vs $754, P < 0.001) and inpatient costs ($39,205 vs $29,550, P < 0.001) compared with IBD patients without MHDs. Patients with MHDs also had significantly higher total annual IBD-related surgical costs ($55,693 vs $40,486, P < 0.001) and nonsurgical costs (medical and pharmacy) ($17,220 vs $11,073, P < 0.001), and paid a larger portion of the total out-of-pocket cost for IBD services ($1017 vs $905, P < 0.001).Patients whose claims data contained both IBD-related and MHD-related diagnoses generated significantly higher costs compared with IBD patients without an MHD diagnosis. Based on these data, we speculate that health care costs might be reduced and the course of patients IBD might be improved if the IBD-treating provider recognized this link and implemented effective behavioral health screening and intervention as soon as an MHD was suspected during management of IBD patients. Studies investigating best screening and intervention strategies for MHDs are needed.

  View details for DOI 10.1093/ibd/izaa030

  View details for Web of Science ID 000606702800011

  View details for PubMedID 32095835

• Medical-Legal-Psychology Partnerships - Innovation in Addressing Social Determinants of Health in Pediatric Primary Care ACADEMIC PEDIATRICS Lawton, R., Whitehead, M., Henize, A., Fink, E., Salamon, M., Kahn, R., Beck, A. F., Klein, M. 2020; 20 (7): 902-904

  View details for Web of Science ID 000571991900007

  View details for PubMedID 32565317

• The Cost of Inflammatory Bowel Disease: An Initiative From the Crohn's & Colitis Foundation. Inflammatory bowel diseases Park, K. T., Ehrlich, O. G., Allen, J. I., Meadows, P. n., Szigethy, E. M., Henrichsen, K. n., Kim, S. C., Lawton, R. C., Murphy, S. M., Regueiro, M. n., Rubin, D. T., Engel-Nitz, N. M., Heller, C. A. 2019

  Abstract

  The Crohn's & Colitis Foundation's Cost of Inflammatory Bowel Disease (IBD) Care Initiative seeks to quantify the wide-ranging health care costs affecting patients living with IBD. We aimed to (1) describe the annualized direct and indirect costs of care for patients with Crohn's disease (CD) or ulcerative colitis (UC), (2) determine the longitudinal drivers of these costs, and (3) characterize the cost of care for newly diagnosed patients.We analyzed the Optum Research Database from the years 2007 to 2016, representing commercially insured and Medicare Advantage-insured patients in the United States. Inclusion for the study was limited to those who had continuous enrollment with medical and pharmacy benefit coverage for at least 24 months (12 months before through 12 months after the index date of diagnosis). The value of patient time spent on health care was calculated as number of workplace hours lost due to health care encounters multiplied by the patients' estimated average wage derived from the Bureau of Labor Statistics. Comparisons between IBD patients and non-IBD patients were analyzed based on demographics, health plan type, and length of follow-up. We used generalized linear models to estimate the association between total annual costs and various patient variables.There were 52,782 IBD patients (29,062 UC; 23,720 CD) included in the analysis (54.1% females). On a per-annual basis, patients with IBD incurred a greater than 3-fold higher direct cost of care compared with non-IBD controls ($22,987 vs $6956 per-member per-year paid claims) and more than twice the out-of-pocket costs ($2213 vs $979 per-year reported costs), with all-cause IBD costs rising after 2013. Patients with IBD also experienced significantly higher costs associated with time spent on health care as compared with controls. The burden of costs was most notable in the first year after initial IBD diagnosis (mean = $26,555). The study identified several key drivers of cost for IBD patients: treatment with specific therapeutics (biologics, opioids, or steroids); ED use; and health care services associated with relapsing disease, anemia, or mental health comorbidity.The costs of care for IBD have increased in the last 5 years and are driven by specific therapeutics and disease features. In addition, compared with non-IBD controls, IBD patients are increasingly incurring higher costs associated with health care utilization, out-of-pocket expenditures, and workplace productivity losses. There is a pressing need for cost-effective strategies to address these burdens on patients and families affected by IBD.

  View details for DOI 10.1093/ibd/izz104

  View details for PubMedID 31112238

• Methotrexate for the Treatment of Pediatric Crohn's Disease: A Systematic Review and Meta-analysis INFLAMMATORY BOWEL DISEASES Colman, R. J., Lawton, R. C., Dubinsky, M. C., Rubin, D. T. 2018; 24 (10): 2135-2141

  Abstract

  Methotrexate (MTX) is an immunomodulator used for the treatment of pediatric inflammatory bowel disease (IBD). There are currently no RCTs that assess the treatment efficacy of methotrexate within the pediatric IBD patient population. This systematic review and meta-analysis assesses the efficacy of MTX therapy among the existing pediatric literature.A systematic literature search was performed using MEDLINE and the Cochrane library from inception until March 2016. Synonyms for 'pediatric', 'methotrexate' and 'IBD' were utilized as both free text and MESH search terms. The studies included contained clinical remission (CR) rates for MTX treatment of pediatric IBD patients 18 yrs old, as mono- or combination therapy. Case studies with <10 patients were excluded. Quality assessment was performed with the Newcastle-Ottawa Scale. Meta-analysis calculated pooled CR rates. A random-effects meta-analysis with forest plots was performed using R.Fourteen (11 monotherapy, 1 combination therapy, 2 both; n = 886 patients) observational studies were eligible out of 202 studies. No interventional studies were identified. The pooled achieved CR rate for pediatric CD patients on monotherapy within 3-6 months was 57.7% (95% CI 48.2-66.6%), (P =0.22; I2 = 29.8%). The CR was 37.1% (95% CI 29.5-45.5%), (P = 0.20; I2 = 37.4%) for maintenance therapy at 12 months. Sub-analysis could not identify CR differences between MTX administration types, thiopurine exposure.This meta-analysis demonstrated that, over 50% of pediatric Crohn's disease patients induced with methotrexate achieved clinical remission, while 12-month remission rate was only 37%. Prospective controlled interventional trials should assess treatment efficacy among patient subgroups. 10.1093/ibd/izy078_video1izy078.video15774883936001.

  View details for DOI 10.1093/ibd/izy078

  View details for Web of Science ID 000449182600006

  View details for PubMedID 29688409

  View details for PubMedCentralID PMC6994018

• Maintenance of Optimal Vitamin D Status in Children and Adolescents With Inflammatory Bowel Disease: A Randomized Clinical Trial Comparing Two Regimens JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Pappa, H. M., Mitchell, P. D., Jiang, H., Kassiff, S., Filip-Dhima, R., DiFabio, D., Quinn, N., Lawton, R. C., Bronzwaer, M. S., Koenen, M., Gordon, C. M. 2014; 99 (9): 3408-3417

  Abstract

  Vitamin D promotes bone health and regulates the immune system, both important actions for pediatric patients with inflammatory bowel disease (IBD). The supplementation dose that would maintain optimal serum 25-hydroxyvitamin D concentration (25OHD ≥ 32 ng/mL) is unknown.The objective of the study was to compare two supplementation regimens' efficacy and safety in maintaining optimal 25OHD in children with IBD.This was a randomized, not blinded, controlled trial.The trial was conducted in the Boston Children's Hospital Clinical and Translational Study Unit.Sixty-three patients, aged 8-18 years with IBD and baseline 25OHD greater than 20 ng/mL were enrolled; 48 completed the study, and one withdrew for adverse events.Arm A received 400 IU of oral vitamin D2 daily (n = 32). Arm B received 1000 IU daily in the summer/fall and 2000 IU in the winter/spring (n = 31).The main outcome was the probability of maintaining 25OHD of 32 ng/mL or greater in all trimonthly visits for 12 months.Three participants in arm A (9.4%) and three in arm B (9.7%) achieved the primary outcome (P = .97). The incidence of adverse events, all minor, did not differ. More participants in arm A developed C-reactive protein level of 1 mg/dL or greater (31% vs 10%, P = .04) and IL-6 greater than 3 pg/mL (54% vs 27%, P = .05).Daily oral vitamin D2 doses up to 2000 IU were inadequate to maintain optimal 25OHD but were well tolerated. The finding of lower incidence of elevated inflammatory markers and cytokines among participants receiving higher vitamin D2 doses merits further study.

  View details for DOI 10.1210/jc.2013-4218

  View details for Web of Science ID 000342341400082

  View details for PubMedID 24926949

  View details for PubMedCentralID PMC4154083

• Treatment of Vitamin D Insufficiency in Children and Adolescents with Inflammatory Bowel Disease: A Randomized Clinical Trial Comparing Three Regimens JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Pappa, H. M., Mitchell, P. D., Jiang, H., Kassiff, S., Filip-Dhima, R., DiFabio, D., Quinn, N., Lawton, R. C., Varvaris, M., Van Straaten, S., Gordon, C. M. 2012; 97 (6): 2134-2142

  Abstract

  Vitamin D insufficiency [serum 25-hydroxyvitamin D (25OHD) concentration less than 20 ng/ml] is prevalent among children with inflammatory bowel disease (IBD), and its treatment has not been studied.The aim of this study was to compare the efficacy and safety of three vitamin D repletion regimens.We conducted a randomized, controlled clinical trial from November 2007 to June 2010 at the Clinical and Translational Study Unit of Children's Hospital Boston. The study was not blinded to participants and investigators.Eligibility criteria included diagnosis of IBD, age 5-21, and serum 25OHD concentration below 20 ng/ml. Seventy-one patients enrolled, 61 completed the trial, and two withdrew due to adverse events.Patients received orally for 6 wk: vitamin D(2), 2,000 IU daily (arm A, control); vitamin D(3), 2,000 IU daily (arm B); vitamin D(2), 50,000 IU weekly (arm C); and an age-appropriate calcium supplement.We measured the change in serum 25OHD concentration (Δ25OHD) (ng/ml). Secondary outcomes included change in serum intact PTH concentration (ΔPTH) (pg/ml) and the adverse event occurrence rate.After 6 wk, Δ25OHD ± se was: 9.3 ± 1.8 (arm A); 16.4 ± 2.0 (arm B); 25.4 ± 2.5 (arm C); P (A vs. C) = 0.0004; P (A vs. B) = 0.03. ΔPTH ± SE was -5.6 ± 5.5 (arm A); -0.1 ± 4.2 (arm B); -4.4 ± 3.9 (arm C); P = 0.57. No participant experienced hypercalcemia or hyperphosphatemia, and the prevalence of hypercalciuria did not differ among arms at follow-up.Oral doses of 2,000 IU vitamin D(3) daily and 50,000 IU vitamin D(2) weekly for 6 wk are superior to 2,000 IU vitamin D(2) daily for 6 wk in raising serum 25OHD concentration and are well-tolerated among children and adolescents with IBD. The change in serum PTH concentration did not differ among arms.

  View details for DOI 10.1210/jc.2011-3182

  View details for Web of Science ID 000306100800067

  View details for PubMedID 22456619

  View details for PubMedCentralID PMC3387426