Abstract
Fragmentation in inpatient care is prevalent among patients with chronic disease and is associated with increased mortality and readmissions. We aimed to determine the current prevalence of fragmentation among hospitalized inflammatory bowel disease patients (IBD), along with associated predictors and outcomes.
We performed a retrospective cohort study using the State Inpatient Database (SID) for New York over the period 2009–2013. The SID is a 95% all-payer sample of inpatient visits supported through the Healthcare Cost and Utilization Project within the Agency for Health Research and Quality. Visits for IBD were identified by ICD9 billing codes and linked by patient identifier. Fragmentation was defined as 30-day readmission to a non-index hospital. A multivariable logistic regression analysis was performed controlling for demographics and other variables which were associated with fragmentation on univariable analysis with a p-value <0.05.
100,758 IBD-related visits were identified, of which 15,257 (15.4%) were considered a 30-day readmission. 27.4% of these readmissions were to a non-index hospital. The trend in fragmentation has persisted over time (Figure 1). Estimates from regression analysis indicate that urgent readmissions, Medicaid as the primary payer, and underlying mood disorder and substance abuse were associated with fragmented care. Fragmentation in care was also associated with in-hospital mortality, inpatient colonoscopy, venous thromboembolism, increased length of stay and increased total charges for the non-index admission (Table 1).
Fragmentation is prevalent among one in four IBD hospitalizations, and is associated with poor visit outcomes. The likelihood of fragmented care is higher among Medicaid beneficiaries and those with psychiatric comorbidities. Chronic care pathways and coordinated care efforts should target these vulnerable populations as part of efforts to incentivize value-based care.
