- Using three large national databases, Massachusetts General Hospital researchers evaluated trends in outpatient, emergency department visits and hospitalizations for inflammatory bowel disease (IBD) in the U.S. between 2005 and 2016
- The number of outpatient visits increased between 2005 and 2010, but plateaued or decreased between 2011 and 2016, a trend primarily driven by a reduction in visits for Crohn's disease
- In contrast, the number of IBD-related emergency department visits and hospitalizations continued to rise throughout the study period
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Because inflammatory bowel disease (IBD) is often diagnosed at a young age and typically has a relapsing and remitting course, most patients have repeated encounters with the health care system. This burden may be increasing due to rising rates of IBD incidence and prevalence.
Christopher Ma, MD, MPH, of the University of Calgary, Canada, Ashwin N. Ananthakrishnan, MBBS, MPH, director of the Mass General Crohn's and Colitis Center at Massachusetts General Hospital, and colleagues recently became the first to use nationwide administrative data to examine U.S. trends in ambulatory and inpatient care for IBD. In Clinical Gastroenterology and Hepatology, they report that the number of ambulatory visits has plateaued or decreased while the numbers of emergency department visits and hospitalizations continue to increase.
The researchers examined data on adult IBD patients in three databases:
- The National Ambulatory Medical Care Survey, where more than 20,000 observations are used to make estimates on almost 1 billion outpatient visits annually
- The Nationwide Emergency Department Sample, through which data are available for the years 2006 to 2016; about 31 million observations are used to make estimates on about 143 million visits nationally
- The National Inpatient Sample, which contains data on ~7 million discharges, used to make estimates on ~35 million hospitalizations nationally
The researchers separated the number of annual outpatient visits into eras:
- Era 1 (2005–2007) — 1.5 million
- Era 2 (2008–2010) — 2.6 million
- Era 3 (2011–2013) — 2.6 million
- Era 4 (2014–2016) — 2.1 million
Thus, the number of annual visits increased by 70% between era 1 and era 2, stabilized in era 3 and decreased by 20% in era 4.
In eras 1 through 3, Crohn's disease (CD) accounted for most IBD outpatient visits, but in era 4, visits related to ulcerative colitis became more frequent than CD-related visits. Ulcerative colitis (UC)-related visits increased by 156% from era 1 to era 4.
The annual number of ED visits related to IBD increased significantly during the period covered by the database, from 86,347 in 2006 to 143,987 in 2016 (P < .0001). The absolute increase in visit rate was 3.2 visits per 10,000 encounters. The rates of both CD-related and UC-related visits increased significantly.
From 2005 to 2016, the annual number of IBD-related hospital discharges increased significantly from 79,939 to 95,960 (P < .0001). The absolute increase was six discharges per 10,000 encounters. As with ED visits, the rates of both CD-related and UC-related hospitalizations increased significantly.
What Explains These Trends?
The increases in ED utilization and hospitalizations are presumably tied to the plateauing of outpatient visits, which in turn may reflect changes in IBD practice patterns, such as:
- Increased use of biologic therapy
- A new emphasis on endoscopic remission as the therapeutic goal
- Closer noninvasive monitoring of inflammatory burden
- Earlier introduction of definitive treatment
It remains to be seen whether these changes in practice will result in better overall disease control.
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