Nghia H Nguyen1, Jiyu Luo2, Lucila Ohno-Machado3, William J Sandborn1, Siddharth Singh1,2. 1. Division of Gastroenterology, La Jolla, California. 2. Division of Biostatistics and Bioinformatics, La Jolla, California. 3. Division of Biomedical Informatics, University of California San Diego, La Jolla, California.
Abstract
BACKGROUND: Fragmentation of care (FoC) may adversely impact health care quality in patients with chronic diseases. We conducted a US nationally representative cohort study to evaluate the burden and outcomes of FoC in hospitalized patients with inflammatory bowel disease (IBD). METHODS: Using Nationwide Readmissions Database 2013, we created 2 cohorts of superutilizer patients with IBD with 2 hospitalizations (cohort 1: FoC, defined as readmission to nonindex hospital vs no FoC) or 3 hospitalizations (cohort 2: multiple episodes of fragmentation vs single episode of fragmentation vs no FoC) between January and June 2013, which were followed through December 2013. We evaluated burden, pattern, and outcomes of fragmentation (6-month risk of readmission, risk of surgery, and inpatient mortality). RESULTS: In cohort 1, of 6073 patients with IBD with 2 admissions within 6 months, 1394 (23%) experienced FoC. Fragmentation of care was associated with modestly higher risk of readmission within 6 months (31% vs 28%, P < 0.01; adjusted relative risk, 1.11 [1.01-1.21]), without differences in risk of surgery (2.8% vs 4.3%, P = 0.19) or in-hospital mortality (0.2% vs 0.5%, P = 0.22). In cohort 2, of 1717 patients with 3 hospitalizations within 6 months, the number of patients with multiple episodes of fragmentation was associated with higher risk of readmission compared with patients with single episode of fragmentation or no FoC (52% vs 49% vs 43%, P = 0.03). CONCLUSIONS: In a US cohort study, FoC is associated with a modestly higher risk of readmission, without higher risk of surgery or mortality in superutilizer patients with IBD. Future studies focusing on impact of outpatient care and postdischarge coordination are warranted in superutilizer patients.
BACKGROUND: Fragmentation of care (FoC) may adversely impact health care quality in patients with chronic diseases. We conducted a US nationally representative cohort study to evaluate the burden and outcomes of FoC in hospitalized patients with inflammatory bowel disease (IBD). METHODS: Using Nationwide Readmissions Database 2013, we created 2 cohorts of superutilizer patients with IBD with 2 hospitalizations (cohort 1: FoC, defined as readmission to nonindex hospital vs no FoC) or 3 hospitalizations (cohort 2: multiple episodes of fragmentation vs single episode of fragmentation vs no FoC) between January and June 2013, which were followed through December 2013. We evaluated burden, pattern, and outcomes of fragmentation (6-month risk of readmission, risk of surgery, and inpatient mortality). RESULTS: In cohort 1, of 6073 patients with IBD with 2 admissions within 6 months, 1394 (23%) experienced FoC. Fragmentation of care was associated with modestly higher risk of readmission within 6 months (31% vs 28%, P < 0.01; adjusted relative risk, 1.11 [1.01-1.21]), without differences in risk of surgery (2.8% vs 4.3%, P = 0.19) or in-hospital mortality (0.2% vs 0.5%, P = 0.22). In cohort 2, of 1717 patients with 3 hospitalizations within 6 months, the number of patients with multiple episodes of fragmentation was associated with higher risk of readmission compared with patients with single episode of fragmentation or no FoC (52% vs 49% vs 43%, P = 0.03). CONCLUSIONS: In a US cohort study, FoC is associated with a modestly higher risk of readmission, without higher risk of surgery or mortality in superutilizer patients with IBD. Future studies focusing on impact of outpatient care and postdischarge coordination are warranted in superutilizer patients.
Authors: Robert E Burke; Christine D Jones; Patrick Hosokawa; Thomas J Glorioso; Eric A Coleman; Adit A Ginde Journal: Med Care Date: 2018-01 Impact factor: 2.983
Authors: Rennier A Martinez; Kelsey N Franklin; Alexandra E Hernandez; Joshua Parreco; Nicholas Cortolillo; Reagan Ross Journal: J Vasc Surg Date: 2019-05-29 Impact factor: 4.268
Authors: Philip N Okafor; Augustine K Nnadi; Okwuchukwu Okoli; Alice E Huang; Obioma Nwaiwu Journal: Am J Gastroenterol Date: 2019-03 Impact factor: 10.864
Authors: Shirley Cohen-Mekelburg; Russell Rosenblatt; Stephanie Gold; Nicole Shen; Brett Fortune; Akbar K Waljee; Sameer Saini; Ellen Scherl; Robert Burakoff; Mark Unruh Journal: Am J Gastroenterol Date: 2019-02 Impact factor: 10.864
Authors: Krishna K Patel; Nirav Vakharia; James Pile; Erik H Howell; Michael B Rothberg Journal: J Gen Intern Med Date: 2016-02-18 Impact factor: 5.128
Authors: James M Dahlhamer; Emily P Zammitti; Brian W Ward; Anne G Wheaton; Janet B Croft Journal: MMWR Morb Mortal Wkly Rep Date: 2016-10-28 Impact factor: 17.586