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

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.