Risk factors for recurrent emergency care utilization for flares in inflammatory bowel disease

Abstract

ObjectivesPatients with inflammatory bowel disease (IBD) need frequent emergency care due to flares of their disease. However, understanding which patients are most vulnerable to repeat emergency care due to recurrent flares of their disease remains poor.MethodsThis was a retrospective cohort study of Kaiser Permanente Northern California health plan members aged ≥ 18 years between 2009 ‐2018. Our primary outcome was occurrence of repeat ED visits with a primary diagnosis code of IBD in the six months following their index ED visit. Baseline characteristics and clinical service use patterns were extracted. We used multivariable negative binomial regression analysis to measure the incident risk of a recurrent ED visit within 6 months.ResultsWe found 2111 patients met eligibility criteria, of which 56.7% were female and 39.7% were non‐white. During the six‐month observation period, 19.3% (n= 408) returned to the ED for a second IBD flare. In adjusted analyses, we found older age (IRR 0.44; 95% CI 0.31‐0.62 for age 60+ compared to 18‐30), higher neighborhood household income (IRR 0.80; CI 0.65‐0.98 for income >= $85,000), and diagnosis of alcohol use disorder were associated with a lower risk of repeat ED utilization (IRR 0.62; CI 0.41‐0.93), while presence of mood disorder (IRR 1.26; CI 1.03‐1.58), history of opiate prescription (IRR 1.38; CI 1.10‐1.73) and corticosteroid prescription (IRR 1.57; CI 1.27‐1.95) were associated with increased risk of repeat ED utilization. Prompt outpatient follow‐up was not associated with a lower odds of recurrent ED utilization (IRR 0.93; CI 0.75‐1.15).ConclusionsOur study identified multiple patient characteristics associated with higher recurrent short‐term use of the ED for IBD care. Although we did not find prompt outpatient follow‐up after initial ED visit to be protective, targeted interventions directed at high‐risk individuals based on mood disorders, opiate use, or steroid use may help to optimize care and healthcare utilization.