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Tu1247 Unplanned Hospital Readmission: Rates and Causes in Patients With Inflammatory Bowel Disease: A Critical Analysis
AGA Abstracts
at our Gastroenterology Day Hospital between January and December 2013 were included. Patients complete Functional Assessment of Chronic Illness Therapy-Fatigue score (FACITCF) as well as psychological scores (Beck for depression, Stai for anxiety, Epworth for sleep disturbances and IBDQ-9 for quality of life) and IBD activity scores. Biological parameters (Interleukin 5, 8, 12, complete blood count, ferritin, C-reactive protein, erythrocyte sedimentation rate and micronutrients) were tested by appropriate blood tests. Results: A total of 219 were studied and at the end of the study 177 patients (mean age, 39 ± 12 years, 28% ulcerative colitis and 72% crohn's disease) were included for the analysis. The median Fatigue score (38, range (1-52)) was lower that than in general population. Twenty-eight (16%) patients had moderate-to-severe fatigue determined as fatigue score of 22 or lower. In the univariate analysis, fatigue differed significatively with gender, type of IBD, Harvey and Mayo score, articular disease, body mass Index (BMI), psychological tests, thiopurine and biological treatment. All these variables were included in the multivariate analysis. Female gender (β-6.61, p<0.001), BMI (β -0.61, p<0.001) and higher depression (β-0.43, p<0.001) and anxiety (β -0.18, p<0.001) scores were predictors of increased fatigue. IBDQ9 (β0.51, p<0.001) was independently related to lower fatigue. Conclusion: Fatigue was prevalent in our IBD patients and was related to high levels of anxiety and depression and low quality of life. None of the biological factors evaluated including pro-inflammatory interleukins or micronutrient deficiencies was associated with fatigue. Tu1247 Unplanned Hospital Readmission: Rates and Causes in Patients With Inflammatory Bowel Disease: A Critical Analysis Prashant R. Mudireddy, Frank I. Scott, Gary R. Lichtenstein Aim: Hospitalizations for exacerbations of IBD are common. Readmission has been deemed a marker of poor quality of care. The aim of the study was to better characterize the rates of unplanned readmissions in IBD patients at 1 month, 3 months and 1 year and to identify the reasons for the unplanned readmissions. Preliminary data was previously presented by our group [Gastroenterology 2013, Vol.144(5),S629], however, this presentation represents extensively updated new data and novel findings. Methods: We retrospectively reviewed the electronic medical record database of our institution (3 large urban academic hospitals) to identify consecutive patients admitted between Jan 2007 to Dec 2010 with a primary discharge diagnosis of either UC or CD. Index admission was defined as first unplanned admission with primary discharge diagnosis of either UC or CD. Readmission was defined as unplanned admission (due to any cause) occurring within 1-mon, 3-mons, or 1-yr from the index admission. Planned readmissions were excluded. Data analyzed included demographics, type of IBD, length of stay, and primary discharge diagnosis for both index admission and readmissions. Results: A total of 439 index admissions with primary discharge diagnosis of IBD were eligible for inclusion in the study. These patients accounted for a total of 785 admissions to the health system during the study period. The unplanned readmission rates were 14.1% at 1 month, 23.7% at 3 months, and 39.2% at 1-yr. Demographics of the study cohort were: mean age 38 yrs, 55% females, 68% Whites, 144 had UC, 295 had CD, mean duration of IBD 10 yrs. Among the 62 patients readmitted at least once in 1 month, 22 were readmitted within 1 week (1 week readmission rate of 5%). The median LOS for pts with readmissions was 7 days versus 5 days for those without readmission. Causes of readmissions are summarized in Tables 1. At 1-month, 52% of pts were readmitted with IBD as their primary discharge diagnosis (39/69). Among non-IBD discharge diagnosis, infection accounted for most readmissions (17%,12/69). A total of 172 pts were readmitted at least once within 1-yr of discharge. The median LOS for pts with readmissions was 6 days versus 5 days for those without readmission. Causes of readmissions are summarized in Table 2. At 1-yr, IBD was the discharge diagnosis for 47% of readmissions (162/346). Among non-IBD related discharge diagnosis, infection (15.6%, 54/346) and abd pain (6.4%, 22/346) accounted for most readmissions. Conclusion: The unplanned readmission rates in IBD pts are high. The most common reasons for readmissions were IBD exacerbations, infections, and abd pain. Future large studies are needed to define national rates of readmissions and risk factors for readmissions in IBD pts. This has the potential to better define risk factors for readmission and improve the quality of care. Causes of Re-admissions at 1 month
Causes of Re-admissions at 1 yr
Tu1248 Screening for Enteric Infection in Inflammatory Bowel Disease Patients Contacting the IBD Helpline and Presenting With Disease Flares Heather E. Johnson, Katharine Wade, Sean Weaver, Simon D. McLaughlin Introduction: We participated in the UK National Audit of inflammatory bowel disease service provision (Royal College of Physicians, 2014). This recommends that >90% of inflammatory bowel disease (IBD) patients with diarrhoea, have a stool sample sent for culture and Clostridium difficile Toxin (CDT) testing on admission to hospital. To date, a national audit reviewing stool testing of patients contacting IBD Helplines for advice with diarrhoea has not been performed; therefore we reviewed the results from our clinical practice of both inpatients and out-patients. Methods: We searched the IBD telephone helpline electronic records from September 2011 to October 2014 to identify known IBD patients presenting with diarrhoea. Electronic records were reviewed to determine if stool samples for standard stool culture and CDT were requested before escalating therapy, and the results of that testing. By searching hospital admission data we identified all patients admitted for >24 hours with a diagnosis of Crohn's disease or ulcerative colitis with symptoms of loose stool and increased frequency during the same time period and reviewed the same
S-835
AGA Abstracts
at our Gastroenterology Day Hospital between January and December 2013 were included. Patients complete Functional Assessment of Chronic Illness Therapy-Fatigue score (FACITCF) as well as psychological scores (Beck for depression, Stai for anxiety, Epworth for sleep disturbances and IBDQ-9 for quality of life) and IBD activity scores. Biological parameters (Interleukin 5, 8, 12, complete blood count, ferritin, C-reactive protein, erythrocyte sedimentation rate and micronutrients) were tested by appropriate blood tests. Results: A total of 219 were studied and at the end of the study 177 patients (mean age, 39 ± 12 years, 28% ulcerative colitis and 72% crohn's disease) were included for the analysis. The median Fatigue score (38, range (1-52)) was lower that than in general population. Twenty-eight (16%) patients had moderate-to-severe fatigue determined as fatigue score of 22 or lower. In the univariate analysis, fatigue differed significatively with gender, type of IBD, Harvey and Mayo score, articular disease, body mass Index (BMI), psychological tests, thiopurine and biological treatment. All these variables were included in the multivariate analysis. Female gender (β-6.61, p<0.001), BMI (β -0.61, p<0.001) and higher depression (β-0.43, p<0.001) and anxiety (β -0.18, p<0.001) scores were predictors of increased fatigue. IBDQ9 (β0.51, p<0.001) was independently related to lower fatigue. Conclusion: Fatigue was prevalent in our IBD patients and was related to high levels of anxiety and depression and low quality of life. None of the biological factors evaluated including pro-inflammatory interleukins or micronutrient deficiencies was associated with fatigue. Tu1247 Unplanned Hospital Readmission: Rates and Causes in Patients With Inflammatory Bowel Disease: A Critical Analysis Prashant R. Mudireddy, Frank I. Scott, Gary R. Lichtenstein Aim: Hospitalizations for exacerbations of IBD are common. Readmission has been deemed a marker of poor quality of care. The aim of the study was to better characterize the rates of unplanned readmissions in IBD patients at 1 month, 3 months and 1 year and to identify the reasons for the unplanned readmissions. Preliminary data was previously presented by our group [Gastroenterology 2013, Vol.144(5),S629], however, this presentation represents extensively updated new data and novel findings. Methods: We retrospectively reviewed the electronic medical record database of our institution (3 large urban academic hospitals) to identify consecutive patients admitted between Jan 2007 to Dec 2010 with a primary discharge diagnosis of either UC or CD. Index admission was defined as first unplanned admission with primary discharge diagnosis of either UC or CD. Readmission was defined as unplanned admission (due to any cause) occurring within 1-mon, 3-mons, or 1-yr from the index admission. Planned readmissions were excluded. Data analyzed included demographics, type of IBD, length of stay, and primary discharge diagnosis for both index admission and readmissions. Results: A total of 439 index admissions with primary discharge diagnosis of IBD were eligible for inclusion in the study. These patients accounted for a total of 785 admissions to the health system during the study period. The unplanned readmission rates were 14.1% at 1 month, 23.7% at 3 months, and 39.2% at 1-yr. Demographics of the study cohort were: mean age 38 yrs, 55% females, 68% Whites, 144 had UC, 295 had CD, mean duration of IBD 10 yrs. Among the 62 patients readmitted at least once in 1 month, 22 were readmitted within 1 week (1 week readmission rate of 5%). The median LOS for pts with readmissions was 7 days versus 5 days for those without readmission. Causes of readmissions are summarized in Tables 1. At 1-month, 52% of pts were readmitted with IBD as their primary discharge diagnosis (39/69). Among non-IBD discharge diagnosis, infection accounted for most readmissions (17%,12/69). A total of 172 pts were readmitted at least once within 1-yr of discharge. The median LOS for pts with readmissions was 6 days versus 5 days for those without readmission. Causes of readmissions are summarized in Table 2. At 1-yr, IBD was the discharge diagnosis for 47% of readmissions (162/346). Among non-IBD related discharge diagnosis, infection (15.6%, 54/346) and abd pain (6.4%, 22/346) accounted for most readmissions. Conclusion: The unplanned readmission rates in IBD pts are high. The most common reasons for readmissions were IBD exacerbations, infections, and abd pain. Future large studies are needed to define national rates of readmissions and risk factors for readmissions in IBD pts. This has the potential to better define risk factors for readmission and improve the quality of care. Causes of Re-admissions at 1 month
Causes of Re-admissions at 1 yr
Tu1248 Screening for Enteric Infection in Inflammatory Bowel Disease Patients Contacting the IBD Helpline and Presenting With Disease Flares Heather E. Johnson, Katharine Wade, Sean Weaver, Simon D. McLaughlin Introduction: We participated in the UK National Audit of inflammatory bowel disease service provision (Royal College of Physicians, 2014). This recommends that >90% of inflammatory bowel disease (IBD) patients with diarrhoea, have a stool sample sent for culture and Clostridium difficile Toxin (CDT) testing on admission to hospital. To date, a national audit reviewing stool testing of patients contacting IBD Helplines for advice with diarrhoea has not been performed; therefore we reviewed the results from our clinical practice of both inpatients and out-patients. Methods: We searched the IBD telephone helpline electronic records from September 2011 to October 2014 to identify known IBD patients presenting with diarrhoea. Electronic records were reviewed to determine if stool samples for standard stool culture and CDT were requested before escalating therapy, and the results of that testing. By searching hospital admission data we identified all patients admitted for >24 hours with a diagnosis of Crohn's disease or ulcerative colitis with symptoms of loose stool and increased frequency during the same time period and reviewed the same
S-835
AGA Abstracts