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A structured bowel management program for patients with severe functional constipation can help decrease emergency
Carlos A Reck-Burneo1, Alejandra Vilanova-Sanchez1, Alessandra C Gasior1
1Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
Insights
A structured bowel management program (BMP) significantly reduced emergency department visits and hospital admissions in children with severe functional constipation. This intervention also lowered associated healthcare costs.
Area of Science:
- Pediatric Gastroenterology
- Health Services Research
Background:
- Constipation in children incurs substantial healthcare costs in the USA, estimated at $3.9 billion annually.
- Severe functional constipation significantly impacts children's health and healthcare utilization.
Purpose of the Study:
- To evaluate the effectiveness of a structured Bowel Management Program (BMP) in reducing healthcare utilization and costs for children with severe functional constipation.
Main Methods:
- A retrospective review of 184 children with severe functional constipation across two centers who participated in an intensive outpatient BMP.
- Data collected included emergency department (ED) visits, hospital admissions, and constipation-related morbidities 12 months before and after BMP completion.
- Objective stool burden assessment via daily radiography was part of the BMP protocol.
Main Results:
- Following BMP, ED visits decreased by 64% (from 34.2% to 12.5% of patients) (p < 0.0005).
- Unplanned hospital admissions saw a 56.9% reduction (from 65 to 28 admissions).
- The study demonstrated significant reductions in key healthcare utilization metrics.
Conclusions:
- A structured BMP is effective in decreasing unplanned ED visits and hospital admissions in pediatric patients with severe functional constipation.
- Implementing a BMP can lead to reduced healthcare costs associated with constipation-related morbidities in children.
Background:
Published health-care costs related to constipation in children in the USA are estimated at $3.9 billion/year. We sought to assess the effect of a bowel management program (BMP) on health-care utilization and costs.
Methods:
At two collaborating centers, BMP involves an outpatient week during which a treatment plan is implemented and objective assessment of stool burden is performed with daily radiography. We reviewed all patients with severe functional constipation who participated in the program from March 2011 to June 2015 in center 1 and from April 2014 to April 2016 in center 2. ED visits, hospital admissions, and constipation-related morbidities (abdominal pain, fecal impaction, urinary retention, urinary tract infections) 12 months before and 12 months after completion of the BMP were recorded.
Results:
One hundred eighty-four patients were included (center 1 = 96, center 2 = 88). Sixty-three (34.2%) patients had at least one unplanned visit to the ED before treatment. ED visits decreased to 23 (12.5%) or by 64% (p < 0.0005). Unplanned hospital admissions decreased from 65 to 28, i.e., a 56.9% reduction (p < 0.0005).
Conclusion:
In children with severe functional constipation, a structured BMP decreases unplanned visits to the ED, hospital admissions, and costs for constipation-related health care.
Level Of Evidence:
3.
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