Appropriateness of Emergency Department Use in Pediatric Inflammatory Bowel Disease

Hoffenberg, Edward J.; Park, K.T.; Dykes, Dana M. H.; Fridge, Jacqueline; Kappelman, Michael D.; Leibowitz, Ian; Tsou, V. Marc; Colletti, Richard B.

doi:10.1097/mpg.0000000000000457

Cited by 13 publications

(11 citation statements)

References 16 publications

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“…Our results also support the findings of Hoffenberg et al, 6 who showed that there was an opportunity to reduce ED visits in a subset of pediatric gastroenterology patients with inflammatory bowel disease. Otherwise, there is little in the literature examining ED use among pediatric specialists.…”

Section: Discussionsupporting

confidence: 82%

Emergency Department Utilization Report to Decrease Visits by Pediatric Gastroenterology Patients

Lee¹,

Greenspan

Israel

et al. 2016

Pediatrics

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The cost of United States health care has outpaced national economic output by 2% per year over the past few decades. 1 At 4% of the total US expenditure on health care, emergency department (ED) visits account for a significant proportion of total health care costs. 2 Previous estimates show that 13.7% to 27.1% of ED visits could potentially be provided at alternative sites and at decreased cost, resulting in savings of $4.4 billion per year. 2,3 Much research has been conducted to address potentially inappropriate ED utilization among pediatric primary care practices. 4 However, few projects and studies have focused on pediatric specialty practices. These specialty practices are especially important at our academic medical center where we have 4 specialist pediatricians for every 1 primary care pediatrician.In 2012, our institution became a Medicare Pioneer Accountable Care Organization (ACO), introducing incentives to reduce the rate of increase of the cost of care per capita across the primary care population. As our primary care practices underwent transformation toward the patientcentered medical home model, the hospital sought a parallel strategy to abstract BACKGROUND AND OBJECTIVES: Emergency department (ED) utilization is a major driver of health care costs. Specialist physicians have an important role in addressing ED utilization, especially at highly specialized, academic medical centers. We sought to investigate whether reporting of ED utilization to specialist physicians can decrease ED visits.

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Section: Discussionsupporting

confidence: 82%

Emergency Department Utilization Report to Decrease Visits by Pediatric Gastroenterology Patients

Lee¹,

Greenspan

Israel

et al. 2016

Pediatrics

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“…IBD-related emergency department (ED) visits are an important area of concern since it is over-utilized by the IBD patients and is a potential target for cost savings [7]. In a recent pediatric IBD study, it was found that at least one-half of all ED encounters could have been avoided in a more responsive and coordinated healthcare system [8]. While the epidemiology of the hospitalized adult IBD patients has been comparatively well studied, the data from the ED setting remain limited [9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Analysis of Hospital-Based Emergency Department Visits for Inflammatory Bowel Disease in the USA

et al. 2015

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The IBD-related ED visits have remained relatively stable from 2009 to 2011. The presence of anemia, malnutrition, hypovolemia, electrolyte abnormalities, fever, abnormal white cell count, bowel obstruction, or intra-abdominal abscess during the ED visit was associated with hospitalization. The presence of bowel obstruction and intra-abdominal abscess was strongly associated with surgical intervention.

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“…It might not be true emergencies and probably could be managed on an outpatient basis because the ER visits did not often result in a hospitalization or surgery. Hoffenberg et al[10] found that one-fifth ER visits for IBD were judged medically unnecessary, and one-half avoidable in a more optimal health care system. van Deen et al [23].…”

Section: Discussionmentioning

confidence: 99%

“…It is important to reduce the utilization of acute care services in relation to the quality of care for chronic intestinal BD and intestinal BD-related disease management. In a recent pediatric IBD study, it was found that at least one-half of all ER visitors could have been avoided in the presence of a more responsive and coordinated health-care system [10]. …”

Section: Introductionmentioning

confidence: 99%

Risk Factors and Outcomes of Emergency Room Visits in Intestinal Behçet’s Disease

Park¹,

Cheon

Park

et al. 2017

Digestion

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Background/Aims: Intestinal Behçet’s disease (BD) is a chronic recurring intestinal vasculitic disorder that can lead to emergency room (ER) visits. We aimed to investigate the independent risk factors associated with intestinal BD-related ER visits. Methods: We retrospectively reviewed 606 patients with intestinal BD registered at the Inflammatory Bowel Disease Clinic of Severance Hospital, Seoul, Korea. Results: One hundred eighty-five patients (30.5%) visited the ER at least once (total visits, 510). In multivariate analysis, lower socioeconomic status (hazard ratio [HR] 1.884), higher comorbidity index (HR 1.548), corticosteroid use (HR 1.459), higher C-reactive protein (CRP; HR 1.375), and higher disease activity index for intestinal BD (DAIBD) score (HR 1.013) were independent risk factors. However, older age (HR 0.982), disease duration (HR 0.850), opioid use (HR 0.528), and higher hemoglobin level (HR 0.944) were significantly associated with decreased ER visits. Conclusions: The ER attendance rate of patients with intestinal BD was 30.5%. Lower socioeconomic status, higher comorbidity index, corticosteroid use, higher CRP, and higher DAIBD score were positively associated with ER visits. Older age, disease duration, opioid use, and higher hemoglobin level were significantly associated with decreased ER visits.

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Appropriateness of Emergency Department Use in Pediatric Inflammatory Bowel Disease

Cited by 13 publications

References 16 publications

Emergency Department Utilization Report to Decrease Visits by Pediatric Gastroenterology Patients

Emergency Department Utilization Report to Decrease Visits by Pediatric Gastroenterology Patients

Analysis of Hospital-Based Emergency Department Visits for Inflammatory Bowel Disease in the USA

Risk Factors and Outcomes of Emergency Room Visits in Intestinal Behçet’s Disease

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