Background & Aims

Patients with inflammatory bowel diseases (IBDs) require repeated health care encounters, although the focus of care differs when patients are seen in ambulatory, emergency department (ED), or inpatient settings. We examined contemporary trends and disparities in IBD-related health care visits.

Methods

We used data from the National Ambulatory Medical Care Survey, the Nationwide Emergency Department Sample, and the National Inpatient Sample to estimate the total number of annual IBD-related visits from 2005 through 2016. We performed logistic regression analyses to test temporal linear trends. Slope and differences in distributions of patient demographics were compared across time and treatment settings.

Results

From 2005 through 2016, approximately 2.2 million IBD-related ambulatory visits (95 CI, 1.9–2.5) occurred annually on average, increasing by 70.3% from the time period of 2005 to 2007 through the time period of 2008 to 2010, and decreasing by 19.8% from the time period of 2011 to 2013 through the time period of 2014 to 2016. An average of 115,934 IBD-related ED visits (95% CI, 113,758–118,111) and 89,111 IBD-related hospital discharges (95% CI, 87,416–90,807) occurred annually. Significant increases in the rate of IBD-related ED visits (3.2 visits/10,000 encounters; P < .0001) and hospital discharges (6.0 discharges/10,000 encounters; P < .0001) were observed from 2005 through 2016. The proportion of patients paying with private insurance decreased from 2005 through 2016, among all care settings. A greater proportion of young patients, patients with Crohn’s disease, non-white patients, and patients with Medicare or Medicaid used hospital-based vs ambulatory services.

Conclusions

In an analysis of data from 3 large databases, we found that although IBD-related ambulatory visits stabilized to decreased from 2005 through 2016, rates of ED use and admission to the hospital have continued to increase with changes in patient demographics, over time and among care settings.

中文翻译：

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评估美国炎症性肠病门诊、急诊和住院就诊的全国趋势和差异（2005-2016）。

背景与目标

炎症性肠病 (IBD) 患者需要反复就诊，但在门诊、急诊科 (ED) 或住院环境中就诊时，护理重点有所不同。我们研究了 IBD 相关医疗保健就诊的当代趋势和差异。

方法

我们使用来自全国门诊医疗调查、全国急诊科样本和全国住院样本的数据来估计 2005 年至 2016 年每年与 IBD 相关的就诊总数。我们进行逻辑回归分析以测试时间线性趋势。跨时间和治疗设置比较了患者人口统计分布的斜率和差异。

结果

从 2005 年到 2016 年，平均每年发生约 220 万次 IBD 相关门诊（95 CI，1.9-2.5），从 2005 年到 2007 年到 2008 年到 2010 年期间增加了 70.3%，并减少了从 2011 年到 2013 年到 2014 年到 2016 年期间的 19.8%。平均 115,934 次 IBD 相关急诊就诊（95% CI，113,758–118,111）和 89,111 次 IBD 相关出院，6875 –90,807) 每年发生一次。IBD 相关急诊就诊率（3.2 次就诊/10,000 次就诊；P < .0001）和出院率（6.0 次出院/10,000次就诊；P< .0001) 从 2005 年到 2016 年观察到。在所有护理机构中，支付私人保险的患者比例从 2005 年到 2016 年下降。更大比例的年轻患者、克罗恩病患者、非白人患者以及医疗保险或医疗补助患者使用基于医院的服务与门诊服务。

结论

在对来自 3 个大型数据库的数据进行分析时，我们发现尽管 IBD 相关的门诊就诊率在 2005 年到 2016 年间稳定下降，但 ED 使用率和入院率随着患者人口统计数据的变化而持续增加，随着时间的推移和护理设置。