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P256. The introduction of a formal IBD service is cost effective in reducing inpatient healthcare utilisation

C. Sack1, V. Pham2, R. Grafton2, D. van Langenberg3, M. Clark4, K. Brett5, G. Holtmann6, J.M. Andrews2

1University Hospital, Essen, Germany; 2IBD Service, Royal Adelaide Hospital, Adelaide, SA, Australia; 3Box Hill Hosiptal, Monash University, Melbourne, Victoria, Australia; 4Costings Unit, Royal Adelaide Hospital, Adelaide, SA, Australia; 5Information & Communication Technology Services, Royal Adelaide Hospital, Adelaide, SA, Australia; 6Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia

Introduction: IBD is a chronic disease. Despite this, care is often “episodic”. We hypothesised that the introduction of a formal IBD Service (IBDS) would improve care, and may decrease healthcare utilisation.

Methods: Two audits were performed of all IBD patients attending a major metropolitan hospital over 5 months from Nov 1 – Mar 31, via diagnostic and coding data in in- and out-patient databases; before and 2 years after introduction of an IBDS. Inpatient healthcare utilization (number of admissions, Total Length of Stay [TLoS]) and care complexity (i.e. relative stay index (RSI)) was compared between separate audit periods (2007/8 & 2009/10).

Results: The first audit captured 233 patients, the second, 228. Of these, 102 (43.8%) were admitted in 2007/8 and 95 (41.7%) in 2009/10. Patients in 2009/10 had significantly fewer admissions (1.53 vs. 1.72, p = 0.05) and fewer of them had high complexity (RSI > 100%) compared to 2007/8 (24 vs. 59, p < 0.0001). All other parameters show a consistent, but non significant, trend to lower HCU in 2010 than 2008 (TLoS 10.5 vs. 13.3, p = 0.348, admission via ED 74 vs. 81, p = 0.692, increased diversity of disease 44 vs. 49, p = 0.758). There was no evidence that HCU varied by IBD diagnosis as all trends applied equally to those with Crohn's or ulcerative colitis. Patients within the second audit had lower total costs for all admissions ($1,105,743 vs. $1,418,581) and lower mean costs per patient ($11,889.71 vs. $14,045.36, p = 0.739). Compared to all other groups, patients with specialist gastroenterologist care and known to the IBDS had the lowest mean number of admissions per patient (GE+IBDS 1.14 vs. noGE+noIBDS 1.64, p = 0.25). Additionally patients with specialist care and IBDS received no opiates or steroids during study period, as compared to other patient groups.

Summary/Conclusions: Healthcare utilization and complexity of care in inpatients with IBD has improved significantly during the last two years. Whilst not all results are statistically significant, all trends consistently show lower HCU and complexity of care with an IBDS. Best outcomes are seen in patients with specialist gastroenterologist care and the IBD Service.