Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Dig Dis Sci. 2024 Dec;69(12):4347-4354. doi: 10.1007/s10620-024-08619-y. Epub 2024 Sep 3.
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.
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.
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.
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.
小儿炎症性肠病（IBD）会带来巨大的医疗保健成本，并给急诊服务带来压力。本研究旨在确定美国东南部一个农村医疗服务不足地区患有 IBD 的儿童中与非计划性医疗保健使用相关的因素。
在这项回顾性队列研究中，我们分析了在 2016 年至 2021 年间在一家学术儿科胃肠病诊所接受治疗的患有中重度 IBD 的儿童（<18 岁）。每次计划就诊都被视为一个单独的观察，在每次计划就诊后对患者进行随访，直到发生最早的非计划性医疗保健事件、下一次计划就诊或截止日期。
在对 70 名 IBD 儿童的 471 次计划就诊进行分析后，我们观察到在 12 个月内发生了 84 次（18%）非计划性就诊，其中 39 次与 IBD 相关。非计划性就诊的中位数间隔为 39 天，主要发生在急诊部（ED）。多变量 Cox 比例风险分析显示，女性患者、C 反应蛋白水平和贫血升高的患者、由医疗补助保险覆盖的患者以及居住在离诊所较近的患者发生非计划性就诊的风险更高。
本研究阐明了农村地区 IBD 儿童面临的挑战。通过确定与非计划性医疗保健利用相关的因素，我们可以更好地确定可能受益于针对性干预措施以减少此类就诊的患者。
