All-cause hospitalizations for inflammatory bowel diseases: Can the reason for admission provide information on inpatient resource use? A study from a large veteran affairs hospital

Malhotra, Ashish; Mandip, KC; Shaukat, Aasma; Rector, Thomas S.

doi:10.1186/s40779-016-0098-x

Cited by 16 publications

(16 citation statements)

References 11 publications

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“…We identified 852 unique studies using our search strategy and reviewed 94 studies in detail and ultimately included 17 studies (6324 patients) in the quantitative analysis. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The study selection flowsheet is included in Figure 1. Of these 17 studies, 7 studies were fulllength articles and 10 were abstracts.…”

Section: Resultsmentioning

confidence: 99%

Rate of Risk Factors for and Interventions to Reduce Hospital Readmission in Patients With Inflammatory Bowel Diseases

Nguyen

Koola

Dulai

et al. 2020

Clinical Gastroenterology and Hepatology

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BACKGROUND & AIMS: We investigated 30-and 90-day rates and causes of, risk factors for, and interventions to reduce hospital readmission in patients who received medical treatment for inflammatory bowel diseases (IBD). METHODS: We performed a systematic search of publications through July 1, 2018 for studies of rates of hospital readmission and associated causes and risk factors in patients who received medical treatments for IBD. Our final analysis included 17 cohort studies (6324 patients) of hospitalized adults with IBD who had received medical treatment, along with reported readmission rates with detailed chart review. We performed random effects meta-analysis to estimate 30-and 90day rates of readmission and identified causes and risk factors associated with readmission. We also performed qualitative analyses of studies that focused on interventions to reduce readmission. RESULTS: Overall, the 30-day rate of readmission was 18.1% (95% CI, 14.4-22.4) and the 90-day rate was 26.0% (95% CI, 22.7-29.6). On meta-regression, studies with higher proportions of patients with ulcerative colitis than Crohn's disease reported higher risks for readmission. Most common reasons for readmission were IBD flare, infection, or complications from unplanned surgeries during hospitalizations. Consistent risk factors for 30-day readmission were admission for pain control (odds ratio [OR], 2.27; 95% CI, 1.69-3.03), need for total parenteral nutrition on discharge (OR, 2.13; 95% CI, 1.36-3.35), and prior or unplanned surgery during admission (OR, 3.11; 95% CI, 2.27-4.25). Only 1 study focused on interventions (specialized inpatient IBD service) to reduce risk of readmission. CONCLUSIONS: Overall 30-and 90-day rates of readmission for patients who received medical treatment for IBD are 18.1% and 26.0%, respectively. IBD flares and infections are common reasons for readmission, and inadequate pain control and need for parenteral nutrition were common risk factors. Interventional studies to reduce risk of readmission are needed.

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Section: Resultsmentioning

confidence: 99%

Rate of Risk Factors for and Interventions to Reduce Hospital Readmission in Patients With Inflammatory Bowel Diseases

Nguyen

Koola

Dulai

et al. 2020

Clinical Gastroenterology and Hepatology

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“…3,11 Although IBD is usually managed in the outpatient setting, acute flares, especially involving hemorrhage or impending bowel perforation, are life-threatening and require hospital admission. 1,11 Despite possibly requiring more resources for acuity of illness, 14 there is a minimal difference in the overall hospitalization mortality, time, or cost of weekend admissions compared with the weekdays. 6 Despite this, the weekend effect has never before been examined in this particular cohort.…”

Section: Discussionmentioning

confidence: 99%

The weekend effect does not influence management of inflammatory bowel disease

et al. 2019

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Background The weekend effect describes worsened outcomes due to perceived inefficiency occurring over the weekend. This effect has not been studied in inflammatory bowel disease (IBD) despite increasing prevalence in the community. Therefore, our aim is to assess differences in the outcomes of weekend versus weekday management of IBD exacerbations. Methods The National Inpatient Sample database comprises approximately 20% of admissions to nonfederal hospitals in the United States. Complications requiring hospitalization (“flares”) were the criteria upon which patient selection was based. A total of 193, 848 flares were identified from 2008 to 2014 using the International Classification of Diseases 9th edition codes. Differences in time to first procedure, length of stay (LOS), and cost were evaluated for patients with flares between weekend and weekday admissions. Results The time to first procedure was 3.33 days on weekends versus 3.19 days on weekdays (P < 0.001). The mean LOS was shorter when admissions occurred on weekends versus weekdays (8.01 days vs 8.22 days, P < 0.001). Finally, the cost of hospitalization was higher for weekday admissions versus weekend admissions ($18 072 vs $17 495, P < 0.001). Conclusion Our results showed a similar LOS and cost associated with the management of exacerbations on the weekend compared to weekdays. While many high‐risk conditions exhibit increased mortality and prolonged hospital course over the weekend, this phenomenon does not appear to affect IBD. These findings indicate efficient patient care on the weekend and can be utilized for logistical purposes such as resource allocation and procedure scheduling in the endoscopy suite.

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“…Although randomized trials in the IBD population to reduce readmissions are lacking, data from other chronic diseases have shown that the use of integrated multidisciplinary clinics to address the social and psychological burdens of chronic illness and the use of nurse case managers or “transitions coach” to improve cross-site communication, encouraging patients to take a more active role in their care by providing guidance, can reduce readmissions and improve outpatient follow-up [ 21 , 22 ]. A previous study in VA patients done by our group demonstrated that IBD patients were more likely to have significant changes in their medication profiles upon discharge from the hospital, thus highlighting the need for transitional care interventions [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for 90-day readmission in veterans with inflammatory bowel disease—Does post-discharge follow-up matter?

Malhotra

Phatharacharukul

2018

Military Med Res

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BackgroundRepeat hospitalizations in veterans with inflammatory bowel disease (IBD) are understudied. The early readmission rate and potentially modifiable risk-factors for 90-day readmission in veterans with IBD were studied to avert avoidable readmissions.MethodsA retrospective cohort study was conducted using the data from veterans who were admitted to the Minneapolis VA Medical Center (MVMC) between January 1, 2007, and December 31, 2013, for an IBD-related problem. All-cause readmissions within 30 and 90 days were recorded to calculate early readmission rates. The multivariate logistic regression was used to identify the potential risk factors for 90-day readmission.ResultsThere were 130 unique patients (56.9% with Crohn’s disease and 43.1% with ulcerative colitis) with 202 IBD-related index admissions. The mean age at the time of index admission was 59.8 ± 15.2 years. The median time to re-hospitalization was 26 days (IQR 10-49), with 30- and 90-day readmission rates of 17.3% (35/202) and 29.2% (59/202), respectively. Reasons for all-cause readmission were IBD-related (71.2%), scheduled surgery (3.4%) and non-gastrointestinal causes (25.4%). The following reasons were independently associated with 90-day readmission: Crohn’s disease (OR 3.90; 95% CI 1.82-8.90), use of antidepressants (OR 2.19; 95% CI 1.12-4.32), and lack of follow-up within 90 days with a primary care physician (PCP) (OR 2.63; 95% CI 1.32-5.26) or a gastroenterologist (GI) (OR 2.44; 95% CI 1.20-5.00). 51.0% and 49.0% of patients had documentation of a recommended outpatient follow-up with PCP and/or GI, respectively.ConclusionsEarly readmission in IBD is common. Independent risk factors for 90-day readmission included Crohn’s disease, use of antidepressants and lack of follow-up visit with PCP or GI. Further research is required to determine if the appropriate timing of post-discharge follow-up can reduce IBD readmissions.

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All-cause hospitalizations for inflammatory bowel diseases: Can the reason for admission provide information on inpatient resource use? A study from a large veteran affairs hospital

Cited by 16 publications

References 11 publications

Rate of Risk Factors for and Interventions to Reduce Hospital Readmission in Patients With Inflammatory Bowel Diseases

Rate of Risk Factors for and Interventions to Reduce Hospital Readmission in Patients With Inflammatory Bowel Diseases

The weekend effect does not influence management of inflammatory bowel disease

Risk factors for 90-day readmission in veterans with inflammatory bowel disease—Does post-discharge follow-up matter?

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