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Predictors of Unplanned Health Care Utilization Among Children with Inflammatory Bowel Disease in a Rural Region of
Catherine Gray1, Reeda Shakir2,3, Dmitry Tumin2
1Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Insights
Unplanned healthcare visits are common for pediatric Inflammatory Bowel Disease (IBD) patients in rural areas. Factors like female sex, anemia, and Medicaid insurance increase the risk for these children.
Area of Science:
- Pediatric Gastroenterology
- Health Services Research
- Rural Health
Background:
- Pediatric Inflammatory Bowel Disease (IBD) presents significant healthcare burdens, particularly in underserved rural regions.
- Unplanned healthcare utilization contributes to increased costs and strains emergency services for pediatric IBD patients.
Purpose of the Study:
- To identify factors associated with unplanned healthcare usage in children with IBD.
- To understand healthcare utilization patterns in a rural, medically underserved area.
Main Methods:
- Retrospective cohort study of children (<18 years) with moderate to severe IBD.
- Analysis of 471 planned visits from 70 pediatric IBD patients between 2016 and 2021.
- Follow-up after planned visits to track unplanned healthcare events.
Main Results:
- 18% of planned visits were followed by an unplanned visit within 12 months; 39 visits were IBD-related.
- Unplanned visits occurred at a median of 39 days, often to the emergency department.
- Higher risk for unplanned visits was associated with female sex, elevated C-reactive protein, anemia, Medicaid insurance, and proximity to the clinic.
Conclusions:
- Children with IBD in rural settings face unique healthcare challenges.
- Identifying specific risk factors can guide targeted interventions to reduce unplanned healthcare utilization.
- This research aids in optimizing care for pediatric IBD patients in underserved areas.
Background:
Pediatric Inflammatory Bowel Disease (IBD) imposes significant healthcare costs and strains emergency services. This study aimed to identify factors associated with unplanned healthcare usage among children with IBD in a rural, medically underserved region in the southeastern United States.
Methods:
In this retrospective cohort study, we analyzed children (<18 years) with moderate or severe IBD followed at an academic pediatric gastroenterology clinic between 2016 and 2021. Each planned visit was treated as a separate observation, and patients were followed after each planned visit until the occurrence of the earliest unplanned healthcare event, until the next planned visit, or until censoring.
Results:
In our analysis of 471 planned visits from 70 children with IBD, we observed 84 (18%) unplanned visits within 12 months, with 39 of these visits related to IBD. Unplanned visits occurred at a median interval of 39 days, predominantly to the emergency department (ED). Multivariate Cox proportional hazards analysis revealed a higher hazard of unplanned visits among female patients, individuals with elevated C-reactive protein levels and anemia, those covered by Medicaid insurance, and those residing closer to the clinic.
Conclusions:
This study elucidates the challenges faced by children with IBD in rural settings. By identifying factors associated with unplanned healthcare utilization, we can better pinpoint patients who may benefit from targeted interventions to reduce such visits.
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