Key result
Missing primary care follow-up within 90 days linked to ~163% higher readmission risk in IBD.
Why the study?
Repeat hospitalizations in veterans with inflammatory bowel disease are understudied, and early readmission rates and modifiable risk factors need evaluation to prevent avoidable readmissions.
Cohort (n=130)
No
In veterans with IBD, lack of outpatient follow-up with a primary care physician or gastroenterologist is an independent risk factor for 90-day readmission.
Answers are grounded in this paper and cite their sources.
May support targeting modifiable factors to reduce veteran IBD readmissions; hypothesis-generating and needs prospective validation.
BACKGROUND: Repeat hospitalizations in veterans with inflammatory bowel disease (IBD) are understudied. The early readmission rate and potentially modifiable risk-factors for 90-day readmission in veterans with IBD were studied to avert avoidable readmissions. METHODS: A retrospective cohort study was conducted using the data from veterans who were admitted to the Minneapolis VA Medical Center (MVMC) between January 1, 2007, and December 31, 2013, for an IBD-related problem. All-cause readmissions within 30 and 90 days were recorded to calculate early readmission rates. The multivariate logistic regression was used to identify the potential risk factors for 90-day readmission. RESULTS: There were 130 unique patients (56.9% with Crohn's disease and 43.1% with ulcerative colitis) with 202 IBD-related index admissions. The mean age at the time of index admission was 59.8 ± 15.2 years. The median time to re-hospitalization was 26 days (IQR 10-49), with 30- and 90-day readmission rates of 17.3% (35/202) and 29.2% (59/202), respectively. Reasons for all-cause readmission were IBD-related (71.2%), scheduled surgery (3.4%) and non-gastrointestinal causes (25.4%). The following reasons were independently associated with 90-day readmission: Crohn's disease (OR 3.90; 95% CI 1.82-8.90), use of antidepressants (OR 2.19; 95% CI 1.12-4.32), and lack of follow-up within 90 days with a primary care physician (PCP) (OR 2.63; 95% CI 1.32-5.26) or a gastroenterologist (GI) (OR 2.44; 95% CI 1.20-5.00). 51.0% and 49.0% of patients had documentation of a recommended outpatient follow-up with PCP and/or GI, respectively. CONCLUSIONS: Early readmission in IBD is common. Independent risk factors for 90-day readmission included Crohn's disease, use of antidepressants and lack of follow-up visit with PCP or GI. Further research is required to determine if the appropriate timing of post-discharge follow-up can reduce IBD readmissions.
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Malhotra et al. (2018) conducted a cohort in Inflammatory bowel disease (n=130). Lack of follow-up with a primary care physician (PCP) vs. Follow-up with a PCP within 90 days was evaluated on 90-day all-cause readmission (OR 2.63, 95% CI 1.32-5.26, p=0.006). Lack of follow-up with a primary care physician within 90 days of discharge was independently associated with an increased risk of 90-day readmission in veterans with inflammatory bowel disease (OR 2.63).
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