Israel Ariel, Sharif Kassem, Zada Galit, Friedenberg Amir, Vinker Shlomo, Lahat Adi
Leumit Research Institute and Department of Family Medicine, Leumit Health Services.
Faculty of Medicine, Tel-Aviv University.
J Clin Gastroenterol. 2024 Oct 22. doi: 10.1097/MCG.0000000000002088.
Inflammatory bowel disease (IBD) encompasses chronic gastrointestinal disorders characterized by recurrent inflammation. Achieving mucosal healing and preventing disease progression are primary treatment goals.
This study aimed to compare disease characteristics, medication utilization, procedures performed, and hospitalizations between IBD patients treated in hospital and community settings using the Leumit Health Service database.
A retrospective cohort study was conducted using data from the Leumit Health Service, comprising 3020 patients diagnosed with IBD from January 2010 to December 2019.
Patients were divided based on primary care setting: hospital-based or community-based. Data included demographic characteristics, disease type, medication usage, procedures, and outcomes. Statistical analyses assessed differences between groups.
Hospital-treated patients were significantly younger (49.4±18.4 vs. 40.4±18.7, P<0.001 ), had higher rates of Crohn's disease (45.9% vs. 71.4%, P<0.001), exhibited higher inflammatory markers (calprotectin 768±2182 vs. 1305±2526, P<0.001), lower albumin (4.23±0.27 vs. 4.12±0.32, P<0.001), hemoglobin levels (13.4±1.6 vs. 12.9±1.6, P<0.001), and lower BMI (26.2±5.3 vs. 24.6±5.6, P<0.001) compared with community-treated patients. Hospital-treated patients had more endoscopic procedures, higher medication utilization rates, shorter treatment durations, and increased hospitalization occurrence (12.1% vs. 23.6%, P<0.001), length (0.67±3.34 vs. 1.45±5.88, P<0.001), and colectomies (4.73% vs. 15.8%, P<0.001).
Disparities exist in IBD management between hospital and community settings, influenced by disease severity and treatment approaches. Hospital-based care is associated with more aggressive disease and intensive interventions, while community-based care may reflect milder disease and conservative management. Integrating specialized care models and personalized approaches across settings can optimize patient outcomes and health care delivery for IBD management. Further research is needed to understand these disparities' underlying mechanisms and develop comprehensive care strategies.
炎症性肠病（IBD）是一类以反复炎症为特征的慢性胃肠道疾病。实现黏膜愈合和预防疾病进展是主要治疗目标。
本研究旨在利用Leumit健康服务数据库比较在医院和社区环境中接受治疗的IBD患者的疾病特征、药物使用情况、所进行的手术以及住院情况。
采用回顾性队列研究，使用Leumit健康服务机构的数据，该数据涵盖了2010年1月至2019年12月期间确诊为IBD的3020例患者。
根据初级保健环境将患者分为两组：以医院为基础或社区为基础。数据包括人口统计学特征、疾病类型、药物使用情况、手术及结果。统计分析评估组间差异。
与社区治疗的患者相比，医院治疗的患者明显更年轻（49.4±18.4岁 vs. 40.4±18.7岁，P<0.001），克罗恩病发病率更高（45.9% vs. 71.4%，P<0.001），炎症标志物水平更高（钙卫蛋白768±2182 vs. 1305±2526，P<0.001），白蛋白水平更低（4.23±0.27 vs. 4.12±0.32，P<0.001），血红蛋白水平更低（13.4±1.6 vs. 12.9±1.6，P<0.001），体重指数更低（26.2±5.3 vs. 24.6±5.6，P<0.001）。医院治疗的患者接受的内镜检查更多，药物使用率更高，治疗持续时间更短，住院发生率更高（12.1% vs. 23.6%，P<0.001），住院时间更长（0.67±3.34天 vs. 1.45±5.88天，P<0.001），结肠切除术发生率更高（4.73% vs. 15.8%，P<0.001）。
医院和社区环境中IBD管理存在差异，受疾病严重程度和治疗方法影响。基于医院的护理与更严重的疾病和强化干预相关，而基于社区的护理可能反映疾病较轻和管理保守。整合不同环境下的专业护理模式和个性化方法可以优化IBD管理的患者结局和医疗服务。需要进一步研究以了解这些差异的潜在机制并制定全面的护理策略。
