Advertisement

Factors That Predict High Health Care Utilization and Costs for Patients With Inflammatory Bowel Diseases

Published:September 16, 2016DOI:https://doi.org/10.1016/j.cgh.2016.09.012

      Background & Aims

      A subset of patients with inflammatory bowel diseases (IBD) have continuously active inflammation, leading to a high number of complications and high direct health care costs (diagnostic tests, medications, and surgeries) and indirect costs (reduced employment and productivity and fewer opportunities for activities). Identifying these high-risk patients and providing effective interventions could produce better outcomes and reduce costs. We used prior year data to create IBD risk models to predict IBD-related hospitalizations, emergency department visits, and high treatment charges (>$30,000/year) in the subsequent year.

      Methods

      We performed a retrospective study of medical records from all patients with IBD treated at the University of Michigan Hospital from fiscal years 2013–2015. We selected clinical variables from the prior year and tested their abilities to predict 3 adverse outcomes (IBD-related hospitalizations, emergency department visits, and treatment charges >$30,000/year) in the subsequent year. Individual patients were only included once in the data set. We created a multivariate model that was based on a 70% randomly selected cohort (1005 patients) and validated the model on the other 30% (425 patients). Logistic regression was used for bivariate and multivariate analyses.

      Results

      Factors that predicted high-cost outcomes included the presence of psychiatric illness, use of corticosteroids, use of narcotics, low levels of hemoglobin, and high numbers of IBD-related hospitalizations. In the validation cohort, the model predicted IBD-related hospitalizations, emergency department visits, and high charges in the following year with receiver operating characteristic curve values of 0.751, 0.738, and 0.744, respectively.

      Conclusions

      We identified 5 factors that can effectively identify patients with IBD at high risk for hospitalization, emergency department visits, and high treatment charges in the next year. These patients should be closely monitored and aggressively managed.

      Keywords

      Abbreviations used in this paper:

      AuROC (area under the receiver operating characteristic curve), CD (Crohn’s disease), CRP (C-reactive protein), ED (emergency department), EMR (electronic medical record), ESR (erythrocyte sedimentation rate), FY (fiscal years), Hgb (hemoglobin), IBD (inflammatory bowel disease), ROC (receiver operating characteristic curve), TNF (tumor necrosis factor), UC (ulcerative colitis)
      To read this article in full you will need to make a payment
      AGA Member Login
      Login with your AGA username and password.
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Solberg I.C.
        • Lygren I.
        • Jahnsen J.
        • et al.
        Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study).
        Scand J Gastroenterol. 2009; 44: 431-440
        • Solberg I.C.
        • Vatn M.H.
        • Hoie O.
        • et al.
        Clinical course in Crohn's disease: results of a Norwegian population-based ten-year follow-up study.
        Clin Gastroenterol Hepatol. 2007; 5: 1430-1438
        • Marri S.R.
        • Buchman A.L.
        The education and employment status of patients with inflammatory bowel diseases.
        Inflamm Bowel Dis. 2005; 11: 171-177
        • Kawalec P.
        • Malinowski K.P.
        Indirect health costs in ulcerative colitis and Crohn's disease: a systematic review and meta-analysis.
        Expert Rev Pharmacoecon Outcomes Res. 2015; 15: 253-266
        • Longobardi T.
        • Jacobs P.
        • Bernstein C.N.
        Work losses related to inflammatory bowel disease in the United States: results from the National Health Interview Survey.
        Am J Gastroenterol. 2003; 98: 1064-1072
        • Prenzler A.
        • Bokemeyer B.
        • von der Schulenburg J.M.
        • et al.
        Health care costs and their predictors of inflammatory bowel diseases in Germany.
        Eur J Health Econ. 2011; 12: 273-283
        • Samuel S.
        • Ingle S.B.
        • Dhillon S.
        • et al.
        Cumulative incidence and risk factors for hospitalization and surgery in a population-based cohort of ulcerative colitis.
        Inflamm Bowel Dis. 2013; 19: 1858-1866
        • Sulz M.C.
        • Siebert U.
        • Arvandi M.
        • et al.
        Predictors for hospitalization and outpatient visits in patients with inflammatory bowel disease: results from the Swiss Inflammatory Bowel Disease Cohort Study.
        Eur J Gastroenterol Hepatol. 2013; 25: 790-797
        • Matsumoto S.
        • Yoshida Y.
        What are the factors that affect hospitalization and surgery for aggravation of ulcerative colitis?.
        Eur J Gastroenterol Hepatol. 2014; 26: 282-287
        • Ramos-Rivers C.
        • Regueiro M.
        • Vargas E.J.
        • et al.
        Association between telephone activity and features of patients with inflammatory bowel disease.
        Clin Gastroenterol Hepatol. 2014; 12: 986-994 e1
        • Click B.
        • Vargas E.J.
        • Anderson A.M.
        • et al.
        Silent Crohn's disease: asymptomatic patients with elevated c-reactive protein are at risk for subsequent hospitalization.
        Inflamm Bowel Dis. 2015; 21: 2254-2261
        • Koutroubakis I.E.
        • Ramos-Rivers C.
        • Regueiro M.
        • et al.
        Persistent or recurrent anemia is associated with severe and disabling inflammatory bowel disease.
        Clin Gastroenterol Hepatol. 2015; 13: 1760-1766
      1. National Health Council. About chronic conditions. 2015 [updated 10/02/2015]. Available from: http://www.nationalhealthcouncil.org/newsroom/about-chronic-conditions. Accessed March 26, 2016.

        • Fireman B.
        • Bartlett J.
        • Selby J.
        Can disease management reduce health care costs by improving quality?.
        Health Aff (Millwood). 2004; 23: 63-75
        • Bates D.W.
        • Saria S.
        • Ohno-Machado L.
        • et al.
        Big data in health care: using analytics to identify and manage high-risk and high-cost patients.
        Health Affair. 2014; 33: 1123-1131
        • Walker J.R.
        • Ediger J.P.
        • Graff L.A.
        • et al.
        The Manitoba IBD cohort study: a population-based study of the prevalence of lifetime and 12-month anxiety and mood disorders.
        Am J Gastroenterol. 2008; 103: 1989-1997
        • Tribbick D.
        • Salzberg M.
        • Ftanou M.
        • et al.
        Prevalence of mental health disorders in inflammatory bowel disease: an Australian outpatient cohort.
        Clin Exp Gastroenterol. 2015; 8: 197-204
        • Click B.
        • Ramos Rivers C.
        • Koutroubakis I.E.
        • et al.
        Demographic and clinical predictors of high healthcare use in patients with inflammatory bowel disease.
        Inflamm Bowel Dis. 2016; 22: 1442-1449
        • Beaugerie L.
        • Seksik P.
        • Nion-Larmurier I.
        • et al.
        Predictors of Crohn's disease.
        Gastroenterology. 2006; 130: 650-656
        • Loly C.
        • Belaiche J.
        • Louis E.
        Predictors of severe Crohn's disease.
        Scand J Gastroenterol. 2008; 43: 948-954
        • Cross R.K.
        • Wilson K.T.
        • Binion D.G.
        Narcotic use in patients with Crohn's disease.
        Am J Gastroenterol. 2005; 100: 2225-2229
        • Targownik L.E.
        • Nugent Z.
        • Singh H.
        • et al.
        The prevalence and predictors of opioid use in inflammatory bowel disease: a population-based analysis.
        Am J Gastroenterol. 2014; 109: 1613-1620
        • Dignass A.U.
        • Gasche C.
        • Bettenworth D.
        • et al.
        European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases.
        J Crohns Colitis. 2015; 9: 211-222
        • Rieder F.
        • Paul G.
        • Schnoy E.
        • et al.
        Hemoglobin and hematocrit levels in the prediction of complicated Crohn's disease behavior: a cohort study.
        PLoS One. 2014; 9: e104706
        • Ananthakrishnan A.N.
        • Issa M.
        • Beaulieu D.B.
        • et al.
        History of medical hospitalization predicts future need for colectomy in patients with ulcerative colitis.
        Inflamm Bowel Dis. 2009; 15: 176-181
        • Wolters F.L.
        • Russel M.G.
        • Sijbrandij J.
        • et al.
        Phenotype at diagnosis predicts recurrence rates in Crohn's disease.
        Gut. 2006; 55: 1124-1130
        • Hoie O.
        • Wolters F.
        • Riis L.
        • et al.
        Ulcerative colitis: patient characteristics may predict 10-yr disease recurrence in a European-wide population-based cohort.
        Am J Gastroenterol. 2007; 102: 1692-1701
        • Kappelman M.D.
        • Rifas-Shiman S.L.
        • Porter C.Q.
        • et al.
        Direct health care costs of Crohn's disease and ulcerative colitis in US children and adults.
        Gastroenterology. 2008; 135: 1907-1913
        • Chow D.K.
        • Sung J.J.
        • Wu J.C.
        • et al.
        Upper gastrointestinal tract phenotype of Crohn's disease is associated with early surgery and further hospitalization.
        Inflamm Bowel Dis. 2009; 15: 551-557