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P326. Decreasing rates of hospital admissions for inflammatory bowel disease between 2000 and 2009

C. Taxonera, J.L. Mendoza, D.M. Cruz-Santamaria, N. López Palacios, C. Alba, M. Cañas, M. Díaz-Rubio

Hospital Clinico, Madrid, Spain

Aims: Although few patients require hospitalization for inflammatory bowel disease (IBD), they tend to generate high resource utilization and account for most of the total costs. In addition, hospitalization negatively affects the patients' quality of life (QOL). In studies in Europe up to 18% of IBD patients require medical hospitalization per year. The aim of this study was to evaluate trends in the medical hospitalization rates in a cohort of IBD patients managed in a specialized IBD unit whose novel approach to management of these patients includes open-access visit follow-up and a close coordination with emergency services.

Materials and Methods: The unit comprises a specialized team of health-care personnel, expert in the treatment of IBD, and caters to a catchment population of 530,000. The annual rate of medical hospitalizations for IBD with respect to the registered patient pool of the unit was evaluated between 2000 and 2009. The registered patient pool included only those patients with confirmed diagnosis of IBD according to standard criteria and with at least one visit during the last 18 months. We extracted from an integrated claim database all inpatients whose hospital discharge reports included ICD-9-CM codes 555 (Crohn's disease [CD]) and 556 (ulcerative colitis [UC]) among the top three discharge diagnoses and only medical hospitalizations were recorded. Those patients whose first and second diagnoses were considered unrelated to IBD complications were excluded. Disease-specific hospitalization rates were also assessed.

Results: The number of patients in the IBD patient pool increased from 431 patients in 2000 to 1202 in 2009, when it comprised 646 men (53.7%); 596 had UC, 570 had CD and 36 had indeterminate colitis. The table shows IBD patients pool, medical admissions and admission/pool rates between 2000 and 2009.

As shown in the table, there was a two-step reduction in admissions rate: between 2001 and 2003–2006 and between 2006 and 2007–2009. This decrease resulting in significant odds ratios (95% IC) (relative to the year 2000 and 2003–2009*, and between 2006 [OR: 1] and 2007–2009 [OR: 0.6, 95% CI 0.4–0.9]), with a highly significant linear trend (p < 0.001). In 2009 the medical hospitalization rate for IBD was 8.9 per 100.000 habitants (5.8 per 100.000 for CD and 3 per 100.000 for UC). Hospitalization for CD accounted for two-thirds of the admissions throughout the study period.

YearPatientsAdmissionsAdmission rateOdds ratio (CI)
20014927214.6%1.1 (0.8–1.5)
20025805910.2%0.8 (0.5–1.0)
2003704436.1%0.5* (0.3–0.7)
2004807506.2%0.5* (0.3–0.7)
2005912616.4%0.5* (0.3–0.7)
2006997585.3%0.4* (0.3–0.6)
20071085393.4%0.3* (0.2–0.4)
20081158433.4%0.3* (0.2–0.4)
20091202473.6%0.3* (0.2–0.4)

Conclusion: Medical hospitalization rates for IBD decreased within a 10-year period. Hospitalization rates in the last 3 years are lower than those described elsewhere. An associated reduction in the direct and indirect costs of IBD would be expected along with an improvement in the patients' QOL.