title: Association between telephone activity and features of patients with inflammatory bowel disease.
abstract: OBJECTIVE
  Telephone communication is common between healthcare providers and patients with inflammatory bowel disease (IBD). We analyzed telephone activity at an IBD care center to identify disease and patient characteristics associated with high levels of telephone activity and determine if call volume could identify individuals at risk for future visits to the emergency department (ED) or hospitalization.
  
  
  METHODS
  We performed a prospective observational study in which we categorized telephone calls received by nursing staff over 2 years at a tertiary care IBD clinic (2475 patients in 2009 and 3118 in 2010). We analyzed data on 21,979 ingoing and outgoing calls in 2009 and 32,667 calls in 2010 and assessed associations between clinical factors and logged telephone encounters, and between patterns of telephone encounters and future visits to the ED or hospitalization.
  
  
  RESULTS
  Telephone encounters occurred twice as frequently as office visits; 15% of the patients generated >10 telephone encounters per year and were responsible for half of all telephone encounters. A higher percentage of these high telephone encounter (HTE) patients were female, had Crohn's disease, received steroid treatment, had increased levels of C-reactive protein and rates of erythrocyte sedimentation, had psychiatric comorbidities, and had chronic abdominal pain than patients with lower telephone encounters. The HTE patients were also more frequently seen in the ED or hospitalized over the same time period and in subsequent years. Forty-two percent of patients with >8 telephone encounters within 30 days were seen in the ED or hospitalized within the subsequent 12 months.
  
  
  CONCLUSIONS
  Based on an analysis of telephone records at an IBD clinic, 15% of patients account for half of all calls. These HTE patients are a heterogeneous group with refractory disease who are likely to visit the ED or be hospitalized.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ramos-Rivers
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Miguel
authors.initials: M
authors.lastname: Regueiro
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Vargas
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Eva
authors.initials: E
authors.lastname: Szigethy
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schoen
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Michael
authors.initials: M
authors.lastname: Dunn
authors.affiliation: Division of Colorectal Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Watson
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Marc
authors.initials: M
authors.lastname: Schwartz
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Jason
authors.initials: J
authors.lastname: Swoger
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Leonard
authors.initials: L
authors.lastname: Baidoo
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Arthur
authors.initials: A
authors.lastname: Barrie
authors.affiliation: Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Anwar
authors.initials: A
authors.lastname: Dudekula
authors.affiliation: Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors.forename: Ada O
authors.initials: AO
authors.lastname: Youk
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Electronic address: binion@pitt.edu.
authors.forename: David G
authors.initials: DG
authors.lastname: Binion
mesh_terms: D000328:Adult; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D058015:Health Communication; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013689:Telephone / Q000706:statistics & numerical data*
keywords: Anxiety; Crohn's Disease; Depression; Electronic Medical Record; Short Inflammatory Bowel Disease Questionnaire; Telephone Calls; Ulcerative Colitis