D0400 - The Differences of Hospitalization Outcomes Between Teaching and Non-Teaching Hospitals in Taking Care of Patients With Inflammatory Bowel Disease in the United Sates

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

ME

Mohammed El-Dallal, MD

Harvard Medical School
Cambridge, Massachusetts

Mohammed El-Dallal, MD¹, Kelsey Anderson, MD², Osama Abu-Shawer, MD, MS³, Joseph D. Feuerstein, MD⁴
¹Harvard Medical School, Cambridge, MA; ²Beth Israel Deaconess Medical Center, Boston, MA; ³Cleveland Clinic, Cleveland, OH; ⁴Beth Israel Deaconess Medical Center (BIDMC), Boston, MA

Introduction: IBD costs continue to rise in the US.¹ Teaching hospitals tend to have more resources for care, but the effect of these resources on cost and utilization is unknown.² We therefore investigated the differences in characteristics and outcomes of patients admitted to teaching hospitals vs non-teaching hospitals.

Methods: We utilized the national inpatient sample data (NIS) 2016-2018³ and hospitalized patients with a 1ry discharge diagnosis of IBD were identified. We excluded all patients who were younger than 18 years and classified our population to those who were admitted to teaching and non-teaching hospitals. Our outcomes included hospital length of stay (LOS), hospital charges, mortality, and discharge disposition. Survey analysis was applied to account for discharge weight and multistage sampling of the NIS data.⁴ We calculated the propensity score for patients based on their demographics, hospital bed size and region, Charlson comorbidity index,⁵ obesity, and tobacco, alcohol, or drug use. We estimated the average treatment effect weight based on the propensity score and used it to adjust differences between the two groups.

Results: 281,440 patients (weighted number) were eligible for our study and 203,815 patients were admitted to teaching hospitals. These patients were more likely to be from larger counties, had private insurance, higher median household income, and their hospitals were more likely to be located at the Northeast or the Midwest (Table 1). In the adjusted analyses, patients who were admitted to teaching facilities had a higher mean difference of LOS (0.82 days, 95% CI 0.7 – 0.94, P < 0.001), hospital charges ($9,482.75, 95%CI 7,336.2 – 11,629.3, P=0.14), higher odds ratio (OR) of discharge with visiting nurse (2.02, 95%CI 1.81 – 2.26, P=< 0.001), and lower OR to be transferred to other hospitals (0.4, 95%CI 0.34 – 0.48, P< 0.001). (Figure 1)

Discussion: In this national analysis of hospitalized patients with IBD, patients who were admitted to teaching hospitals were associated with higher utilization of healthcare resources even after adjusting for demographic, hospitals differences, and comorbidities. Further studies are needed to understand the differences in care at teaching and non-teaching hospitals to explain the cause for the increased utilization of resources in teaching hospitals compared to non-teaching hospitals.

Figure: Figure 1. The hospitalization outcomes for patients with Inflammatory Bowel Disease based on their hospital type, teaching vs non-teaching facilities.

Characteristics	Teaching Hospitals	Non- teaching Hospitals	P value
Total number (Weighted)	203,815	77,625
Age (mean (SD))	44.56 (17.81)	47.74 (18.33)	< 0.001
Female (%)	108,075 (53)	42,730 (55.1)	< 0.001
Race (%)			< 0.001
White	139,595 (71.0)	59,149.9 (78.7)
Black	30,525 (15.5)	7,785 (10.4)
Hispanic	17,065 (8.7)	5,185 (6.9)
Others	9,505 (4.8)	3,075 (4.1)
Patient Location: NCHS Urban-Rural Code (%)			< 0.001
"Central" counties of ≥1 million population	68,235 (33.6)	12,725 (16.4)
"Fringe" counties of ≥1 million population	57,420 (28.3)	20,360 (26.3)
Counties of 250,000-999,999 population	42,580 (21.0)	13,740 (17.7)
Counties of 50,000-249,999 population	16,120 (7.9)	8,890 (11.5)
Not metropolitan or micropolitan counties	18,685 (9.2)	21,739.9 (28.1)
Expected primary payer (%)			< 0.001
Medicare	48,645 (23.9)	23,385 (30.2)
Medicaid	39,290 (19.3)	14,000 (18.1)
Private insurance	98,510 (48.4)	32,045 (41.4)
Self-pay/ Others/No charge	17,100 (8.4)	8,025 (10.4)
Median household income for patients ZIP Code (%)			< 0.001
0-25th percentile	48,885 (24.3)	22,435 (29.4)
26th to 50th percentile	47,765 (23.8)	22,730 (29.8)
51st to 75th percentile	53,400 (26.6)	17,320 (22.7)
76th to 100th percentile	50,780 (25.3)	13,845 (18.1)
Weighted Charlson Comorbidity (mean (SD))	0.64 (1.30)	0.68 (1.30)	0.003
Alcohol use disorder (%)	3,655 (1.8)	1,670 (2.2)	0.007
Drug use disorder (%)	12,795 (6.3)	4,600 (5.9)	0.16
Tobacco use (history and current) (%)	34,295 (16.8)	15,345 (19.8)	< 0.001
Patients with Obesity (%)	18,370 (9)	6545 (8.4)	< 0.001
Weekend admissions (%)	40,890 (20.1)	17,940 (23.1)	< 0.001
Bed size of the hospital (%)			< 0.001
Small	40,970 (20.1)	12,300 (15.8)
Medium	55,340 (27.2)	23,860 (30.7)
Large	107,505 (52.7)	41,465 (53.4)
Region of the hospital (%)			< 0.001
Northeast	49,705 (24.4)	10,870 (14.0)
Midwest	51,420 (25.2)	17,025 (21.9)
South	71,525 (35.1)	35,110 (45.2)
West	31,165 (15.3)	14,620 (18.8)

Table: Table1. Baseline characteristics for hospitalized patients with IBD comparing patients who were admitted to teaching vs non-teaching hospitals.

Disclosures:

Mohammed El-Dallal indicated no relevant financial relationships.

Kelsey Anderson indicated no relevant financial relationships.

Osama Abu-Shawer indicated no relevant financial relationships.

Joseph Feuerstein indicated no relevant financial relationships.

Mohammed El-Dallal, MD¹, Kelsey Anderson, MD², Osama Abu-Shawer, MD, MS³, Joseph D. Feuerstein, MD⁴. D0400 - The Differences of Hospitalization Outcomes Between Teaching and Non-Teaching Hospitals in Taking Care of Patients With Inflammatory Bowel Disease in the United Sates, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.