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Determinants of Healthcare Utilization Among Veterans with Inflammatory Bowel Disease

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Abstract

Background

Identifying patient-level and disease-specific predictors of healthcare utilization in inflammatory bowel disease (IBD) may allow targeted interventions to reduce costs and improve outcomes.

Aim

To identify demographic and clinical predictors of healthcare utilization among veterans with IBD.

Methods

We conducted a single-center cross-sectional study of veterans with IBD from 1998 to 2010. Demographics and disease characteristics were abstracted by manual chart review. Annual number of IBD-related visits was estimated by dividing total number of IBD-related inpatient and outpatient encounters by duration of IBD care. Associations between predictors of utilization were determined using stepwise multivariable linear regression.

Results

Overall, 676 patients (56% ulcerative colitis (UC), 42% Crohn’s disease (CD), and 2% IBD unclassified (IBDU)) had mean 3.08 IBD-related encounters annually. CD patients had 3.59 encounters compared to 2.73 in UC (p < 0.01). In the multivariable model, Hispanics had less visits compared to Caucasians and African-Americans (2.09 vs. 3.09 vs. 3.42), current smokers had more visits than never smokers (3.54 vs. 2.43, p = 0.05), and first IBD visit at age <40 had more visits than age >65 (3.84 vs. 1.75, p = 0.04). UC pancolitis was associated with more visits than proctitis (3.47 vs. 2.15, p = 0.04). CD penetrating phenotype was associated with more encounters than inflammatory type (4.68 vs. 4.15, p = 0.04).

Conclusions

We found that current tobacco use, age <40 at first IBD visit, UC pancolitis, and CD fistuilizing phenotype in addition to Caucasian and African-American race were independent predictors of increased healthcare utilization. Interventions should be targeted at these groups to decrease healthcare utilization and costs.

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Acknowledgments

This study was funded in part by the VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, at the Michael E. DeBakey VA Medical Center, Houston, TX (JKH), Grant Number (#CIN 13-413).

Author’s contributions

MT contributed in design, content, analyses, and primary authorship of manuscript. HES contributed in design, analyses, and editorial input in the manuscript. JH contributed in design, analyses, and editorial input in the manuscript. All authors approved the final version of final draft submitted, including authorship list.

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Correspondence to Mimi C. Tan.

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Conflict of interest

JKH has served as a speaker, a consultant, and an advisory board member for Abbvie, UCB and has received research funding from American Gastroenterology Association, Crohn’s and Colitis Foundation of America, Agency for Healthcare Research and Quality, Pfizer, Celgene, Redhill Biopharma, Abbvie. The remaining authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Tan, M.C., El-Serag, H.B. & Hou, J.K. Determinants of Healthcare Utilization Among Veterans with Inflammatory Bowel Disease. Dig Dis Sci 62, 607–614 (2017). https://doi.org/10.1007/s10620-016-4414-9

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  • DOI: https://doi.org/10.1007/s10620-016-4414-9

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