Fragmented Care is Prevalent Among Inflammatory Bowel Disease Readmissions and is Associated With Worse Outcomes

Cohen‐Mekelburg, Shirley; Rosenblatt, Russell; Gold, Stephanie; Shen, Nicole T.; Fortune, Brett E.; Waljee, Akbar K.; Saini, Sameer D.; Scherl, Ellen; Burakoff, Robert; Unruh, Mark Aaron

doi:10.1038/s41395-018-0417-9

Cited by 36 publications

(35 citation statements)

References 26 publications

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“…A substantial proportion of patients, however, accessed care from different hospital providers, particularly when using accident and emergency services (26.7% of accident and emergency encounters). This is an important finding that is congruent with previous research on the prevalence of fragmentation in IBD care[16] and underscores the need for effective systems to manage transitions of care and sharing of patient information between settings. Centralisation of care between hospitals is increasingly common in healthcare systems around the world and these findings may be replicated in other systems internationally.…”

Section: Discussionsupporting

confidence: 85%

“…Fragmentation of patient care is characterised by ineffective communication among providers and across healthcare agencies, insufficient patient and caregiver education, poor continuity of care, including medication reconciliation, and limited access to services, which contributes to negative quality and cost outcomes[15]. Fragmented inpatient care has been shown to be associated with a higher likelihood of in-hospital mortality, colonoscopy and longer readmission length of stay[16]. An increasing range of investigations and treatment options for IBD[17] adds further complexity to care transitions and necessitates the transfer of accurate and contemporaneous information at a secondary and tertiary care level.…”

Section: Introductionmentioning

confidence: 99%

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Transitions of care across hospital settings in patients with inflammatory bowel disease

Warren¹,

Clarke²,

Arora³

et al. 2019

WJG

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BACKGROUND Inflammatory bowel disease (IBD) is a chronic, inflammatory disorder characterised by both intestinal and extra-intestinal pathology. Patients may receive both emergency and elective care from several providers, often in different hospital settings. Poorly managed transitions of care between providers can lead to inefficiencies in care and patient safety issues. To ensure that the sharing of patient information between providers is appropriate, timely, accurate and secure, effective data-sharing infrastructure needs to be developed. To optimise inter-hospital data-sharing for IBD patients, we need to better understand patterns of hospital encounters in this group. AIM To determine the type and location of hospital services accessed by IBD patients in England. METHODS This was a retrospective observational study using Hospital Episode Statistics, a large administrative patient data set from the National Health Service in England. Adult patients with a diagnosis of IBD following admission to hospital were followed over a 2-year period to determine the proportion of care accessed at the same hospital providing their outpatient IBD care, defined as their ‘home provider’. Secondary outcome measures included the geographic distribution of patient-sharing, regional and age-related differences in accessing services, and type and frequency of outpatient encounters. RESULTS 95055 patients accessed hospital services on 1760156 occasions over a 2-year follow-up period. The proportion of these encounters with their identified IBD ‘home provider’ was 73.3%, 87.8% and 83.1% for accident and emergency, inpatient and outpatient encounters respectively. Patients living in metropolitan centres and younger patients were less likely to attend their ‘home provider’ for hospital services. The most commonly attended specialty services were gastroenterology, general surgery and ophthalmology. CONCLUSION Transitions of care between secondary care settings are common for patients with IBD. Effective systems of data-sharing and care integration are essential to providing safe and effective care for patients. Geographic and age-related patterns of care transitions identified in this study may be used to guide interventions aimed at improving continuity of care.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Transitions of care across hospital settings in patients with inflammatory bowel disease

Warren¹,

Clarke²,

Arora³

et al. 2019

WJG

View full text Add to dashboard Cite

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“…Fragmentation of care (readmission to a nonindex hospital) may occur in 26%-33% patients with IBD and contributes to inferior patient outcomes. 36 Due to this, our estimates on readmission risk may be underestimated. Third, there is limited information on potentially modifiable risk factors for readmission, without details of postdischarge interventions in hospitalized patients that may modify risk of readmission.…”

Section: Discussionmentioning

confidence: 97%

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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“…The use of multiple inpatient IBD services is also common. In another administrative dataset, from the USA, up to 33% of inpatients with IBD were readmitted to a different IBD service within 90 days 9. Again, younger patients were more susceptible to this care fragmentation, which was associated with worsening lengths of stay and in-hospital mortality 9…”

Section: Discussionmentioning

confidence: 99%

Quality of care in adult patients with inflammatory bowel disease transferring between healthcare providers: multicentre audit

Ahmad

Ayubi

Clough

et al. 2020

Frontline Gastroenterol

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BackgroundInflammatory bowel disease (IBD) predominantly affects young adults at critical socioeconomic periods of their lives. There are no studies examining the process of transfer of care for adult patients with IBD changing healthcare providers. Our aims were to assess the quality of referral information provided when patients with an established IBD diagnosis transfer care between heathcare providers and to assess the impact of referral quality on patient outcome.MethodsRetrospective data pertaining to IBD transfer of care referrals were collected from 16 hospitals across London over a 2-month period. Data were collected on patient demographics, source and content of referral and cross-referenced with an established transfer of care checklist. Patient outcome within the 6 months following transfer was also documented.Results154 cases were identified, over half of which transferred due to patient relocation. Details included in transfer letters were in many cases incomplete. In over 70% of cases, the letter came from primary care, including when a tertiary opinion was sought. Although referrals from primary care contained fewer patient data points, there was no association with poor patient outcomes at 6 months.ConclusionThis is the first study examining the quality of transfer of care in adult patients with IBD. We highlighted a significant and underreported issue and found that the majority of referrals were led by primary care. Though the inclusion in the referral of fewer data points was not associated with poor outcomes, we highlighted an area where gastroenterologists might take more responsibility to provide smooth and robust transfer of care.

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Fragmented Care is Prevalent Among Inflammatory Bowel Disease Readmissions and is Associated With Worse Outcomes

Cited by 36 publications

References 26 publications

Transitions of care across hospital settings in patients with inflammatory bowel disease

Transitions of care across hospital settings in patients with inflammatory bowel disease

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

Quality of care in adult patients with inflammatory bowel disease transferring between healthcare providers: multicentre audit

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