Rahul S Dalal1, Ravy K Vajravelu2, James D Lewis2, Gary R Lichtenstein2. 1. Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 2. Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: Hospitalizations contribute significantly to the annual health care expenditure for inflammatory bowel disease (IBD), and reducing cost of care without compromising outcomes is a rising priority. Teaching hospitals (THs) have higher costs and utilize trainees in care to a greater extent than community hospitals, and it is unknown how hospital teaching status (HTS) affects outcomes. We therefore sought to investigate the impact of HTS on IBD hospitalization outcomes. METHODS: We used the Vizient clinical database to identify patients hospitalized between October 1, 2014, and March 31, 2018, for IBD. Vizient hospitals were divided into major THs, minor THs, and non-THs. We used multivariable linear regression of aggregated discharge data to assess the association of HTS with mean length of stay (LOS), mean direct cost (DC), 30-day readmission rate (RR), and in-hospital mortality rate (MR), while adjusting for demographics and disease complexity. RESULTS: Vizient included 29,863 discharges among 291 hospitals for ulcerative colitis (UC) and 62,698 discharges among 314 hospitals for Crohn's disease (CD) between October 1, 2014, and March 31, 2018. Unadjusted mean LOS, mean DC, and 30-day RR were greater among THs for both UC and CD. Unadjusted MR was greater among major THs for UC but not CD. After multivariable analysis, only 30-day RR for UC was increased in major THs relative to non-THs (1.98%; 95% confidence interval, 0.33%-3.61%). CONCLUSIONS: Differences in metrics of cost-effective hospital care for patients with IBD appear to be driven by disease severity rather than HTS. Future research should attempt to better characterize factors driving resource utilization for IBD hospitalizations.
BACKGROUND: Hospitalizations contribute significantly to the annual health care expenditure for inflammatory bowel disease (IBD), and reducing cost of care without compromising outcomes is a rising priority. Teaching hospitals (THs) have higher costs and utilize trainees in care to a greater extent than community hospitals, and it is unknown how hospital teaching status (HTS) affects outcomes. We therefore sought to investigate the impact of HTS on IBD hospitalization outcomes. METHODS: We used the Vizient clinical database to identify patients hospitalized between October 1, 2014, and March 31, 2018, for IBD. Vizient hospitals were divided into major THs, minor THs, and non-THs. We used multivariable linear regression of aggregated discharge data to assess the association of HTS with mean length of stay (LOS), mean direct cost (DC), 30-day readmission rate (RR), and in-hospital mortality rate (MR), while adjusting for demographics and disease complexity. RESULTS: Vizient included 29,863 discharges among 291 hospitals for ulcerative colitis (UC) and 62,698 discharges among 314 hospitals for Crohn's disease (CD) between October 1, 2014, and March 31, 2018. Unadjusted mean LOS, mean DC, and 30-day RR were greater among THs for both UC and CD. Unadjusted MR was greater among major THs for UC but not CD. After multivariable analysis, only 30-day RR for UC was increased in major THs relative to non-THs (1.98%; 95% confidence interval, 0.33%-3.61%). CONCLUSIONS: Differences in metrics of cost-effective hospital care for patients with IBD appear to be driven by disease severity rather than HTS. Future research should attempt to better characterize factors driving resource utilization for IBD hospitalizations.
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