title: Determinants of Healthcare Utilization Among Veterans with Inflammatory Bowel Disease.
abstract: Identifying patient-level and disease-specific predictors of healthcare utilization in inflammatory bowel disease (IBD) may allow targeted interventions to reduce costs and improve outcomes.
  
  
  
  To identify demographic and clinical predictors of healthcare utilization among veterans with IBD.
  
  
  
  We conducted a single-center cross-sectional study of veterans with IBD from 1998 to 2010. Demographics and disease characteristics were abstracted by manual chart review. Annual number of IBD-related visits was estimated by dividing total number of IBD-related inpatient and outpatient encounters by duration of IBD care. Associations between predictors of utilization were determined using stepwise multivariable linear regression.
  
  
  
  Overall, 676 patients (56% ulcerative colitis (UC), 42% Crohn's disease (CD), and 2% IBD unclassified (IBDU)) had mean 3.08 IBD-related encounters annually. CD patients had 3.59 encounters compared to 2.73 in UC (p < 0.01). In the multivariable model, Hispanics had less visits compared to Caucasians and African-Americans (2.09 vs. 3.09 vs. 3.42), current smokers had more visits than never smokers (3.54 vs. 2.43, p = 0.05), and first IBD visit at age <40 had more visits than age >65 (3.84 vs. 1.75, p = 0.04). UC pancolitis was associated with more visits than proctitis (3.47 vs. 2.15, p = 0.04). CD penetrating phenotype was associated with more encounters than inflammatory type (4.68 vs. 4.15, p = 0.04).
  
  
  
  We found that current tobacco use, age <40 at first IBD visit, UC pancolitis, and CD fistuilizing phenotype in addition to Caucasian and African-American race were independent predictors of increased healthcare utilization. Interventions should be targeted at these groups to decrease healthcare utilization and costs.
authors.affiliation: Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine Medical Center, 7200 Cambridge St., Suite 10C, Houston, TX, 77030, USA. mc2@bcm.edu.|Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA. mc2@bcm.edu.
authors.forename: Mimi C
authors.initials: MC
authors.lastname: Tan
authors.affiliation: Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine Medical Center, 7200 Cambridge St., Suite 10C, Houston, TX, 77030, USA.|Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
authors.affiliation: Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine Medical Center, 7200 Cambridge St., Suite 10C, Houston, TX, 77030, USA.|Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Hou
mesh_terms: D000328:Adult; D001741:Black or African American; D017668:Age of Onset; D000368:Aged; D003093:Colitis, Ulcerative / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D003365:Costs and Cost Analysis; D003424:Crohn Disease / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D058014:Veterans Health / Q000191:economics / Q000208:ethnology / Q000706:statistics & numerical data; D044465:White People
keywords: Crohn’s disease; Health service utilization; Healthcare utilization; Inflammatory bowel disease; Outcomes research; Ulcerative colitis