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.
Similar content being viewed by others
References
Kappelman MD, Rifas-Shiman SL, Porter CQ, et al. Direct health care costs of Crohn’s disease and ulcerative colitis in US children and adults. Gastroenterology. 2008;135:1907–1913.
Sewell JL, Velayos FS. Systematic review: the role of race and socioeconomic factors on IBD healthcare delivery and effectiveness. Inflamm Bowel Dis. 2013;19:627–643.
Sulz MC, Siebert U, Arvandi M, et al. Predictors for hospitalization and outpatient visits in patients with inflammatory bowel disease. Eur J Gastroenterol Hepatol. 2013;25:790–797.
Siebert U, Wurm J, Gothe RM, et al. Predictors of temporary and permanent work disability in patients with inflammatory bowel disease: results of the swiss inflammatory bowel disease cohort study. Inflamm Bowel Dis. 2013;19:847–855.
Kappelman MD, Porter CQ, Galanko JA, et al. Utilization of healthcare resources by U.S. children and adults with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:62–68.
van Deen WK, van Oijen MGH, Myers KD, et al. A nationwide 2010–2012 analysis of U.S. health care utilization in inflammatory bowel diseases. Inflamm Bowel Dis. 2014;20:1747–1753.
Prenzler A, Bokemeyer B, Von Der Schulenburg JM, et al. Health care costs and their predictors of inflammatory bowel diseases in Germany. Eur J Heal Econ. 2011;12:273–283.
Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989;170:2–6.
Satsangi J, Silverberg MS, Vermeire S, et al. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749–753.
Lacy BE, Weiser KT, Kennedy AT, et al. Functional dyspepsia: the economic impact to patients. Aliment Pharmacol Ther. 2013;38:170–177.
Dapoigny M, Dyard F, Grimaud J-C, et al. Irritable bowel syndrome and healthcare consumption. An observational study in private gastroenterology. Gastroentérologie Clin Biol. 2003;27:265–271.
Thein HH, Qiao Y, Young SK, et al. Trends in health care utilization and costs attributable to hepatocellular carcinoma, 2002–2009: a population-based cohort study. Curr Oncol. 2016;23:e196–e220.
Damas OM, Jahann DA, Reznik R, et al. Phenotypic manifestations of inflammatory bowel disease differ between Hispanics and non-Hispanic whites: results of a large cohort study. Am J Gastroenterol. 2013;108:231–239.
Lin KK, Sewell JL. The effects of race and socioeconomic status on immunomodulator and anti-tumor necrosis factor use among ambulatory patients with inflammatory bowel disease in the United States. Am J Gastroenterol. 2013;108:1824–1830.
Hou J, El-Serag H, Sellin J, et al. Inflammatory bowel disease characteristics and treatment in Hispanics and Caucasians. Dig Dis Sci. 2011;56:1476–1481. doi:10.1007/s10620-011-1629-7.
Nguyen GC, LaVeist TA, Harris ML, et al. Racial disparities in utilization of specialist care and medications in inflammatory bowel disease. Am J Gastroenterol. 2010;105:2202–2208.
Nguyen GC, Sheng L, Benchimol EI. Health Care utilization in elderly onset inflammatory bowel disease: a population-based study. Inflamm Bowel Dis. 2015;21:777–782.
Lee JH, Cheon JH, Moon CM, et al. Do patients with ulcerative colitis diagnosed at a young age have more severe disease activity than patients diagnosed when older? Digestion. 2010;81:237–243.
Beaugerie L, Sokol H. Clinical, serological and genetic predictors of inflammatory bowel disease course. World J Gastroenterol. 2012;18:3806–3813.
Cuffari C. Diagnostic considerations in pediatric inflammatory bowel disease management. Gastroenterol Hepatol. 2009;5:775–783.
Lakatos PL, Vegh Z, Lovasz BD, et al. Is current smoking still an important environmental factor in inflammatory bowel diseases? Results from a population-based incident cohort. Inflamm Bowel Dis. 2013;19:1010–1017.
Lovasz BD, Lakatos L, Horvath A, et al. Evolution of disease phenotype in adult and pediatric onset Crohn’s disease in a population-based cohort. World J Gastroenterol. 2013;19:2217–2226.
Russel MG, Volovics A, Schoon EJ, et al. Inflammatory bowel disease: is there any relation between smoking status and disease presentation? European Collaborative IBD Study Group. Inflamm Bowel Dis. 1998;4:182–186.
Parkes GC, Whelan K, Lindsay JO. Smoking in inflammatory bowel disease: impact on disease course and insights into the aetiology of its effect. J Crohns Colitis. 2014;8:717–725.
Nguyen GC, Bollegala N, Chong CA. Factors associated with readmissions and outcomes of patients hospitalized for inflammatory bowel disease. Clin Gastroenterol Hepatol. 2014;12:1897e1–1904e1.
Kuwahara E, Murakami Y, Nakamura T, et al. Factors associated with exacerbation of newly diagnosed mild ulcerative colitis based on a nationwide registry in Japan. J. Gastroenterol. 2016. doi:10.1007/s00535-016-1209-x.
Sicilia B, Vicente R, Arroyo MT, et al. Ulcerative pancolitis predicts the need for colectomy: study of an incident cohort of patients with ulcerative colitis in Aragón (Spain). Gastroenterol Hepatol. 2005;28:55–59.
Reigada LC, Bruzzese J-M, Benkov KJ, et al. Illness-specific anxiety: implications for functioning and utilization of medical services in adolescents with inflammatory bowel disease. J Spec Pediatr Nurs. 2011;16:207–215.
Farrokhyar F, Marshall JK, Easterbrook B, et al. Functional gastrointestinal disorders and mood disorders in patients with inactive inflammatory bowel disease: prevalence and impact on health. Inflamm Bowel Dis. 2006;12:38–46.
Cho O-H, Yoo Y-S, Yang S-K. Depression and risk factors in patients with Crohn’s disease. J Korean Acad Nurs. 2012;42:207–216.
Besharat S, Amiriani T, Roshandel G, et al. Depressive mood and disease activity in inflammatory bowel disease. Arab J Gastroenterol. 2012;13:136–138.
Trivedi RB, Post EP, Sun H, et al. Prevalence, comorbidity, and prognosis of mental health among US veterans. Am J Public Health. 2015;105:2564–2569.
Singh H, Nugent Z, Targownik LE, et al. Health care use by a population-based cohort of children with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2015;13:e3.
Ramos-Rivers C, Regueiro M, Vargas EJ, et al. Association between telephone activity and features of patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2014;12:986e1–994e1.
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-016-4414-9