There is limited data published on resource utilization in patients with Ulcerative Colitis. We aimed to find out influence of patient and hospital characteristics on length of stay and cost of care.Methods:
The study cohort was derived from the Nationwide Inpatient sample (NIS) of 2012 to 2013, a subset of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ). We identify Ulcerative Colitis using ICD 9 diagnosis code (556.xx) in principle diagnosis filed. we excluded patients with missing information on age, sex and mortality. Patients with age ≤18 years were excluded as well. Co-morbidities were identified by “cm_” variables in HCUP database. Comorbid conditions were defined by Charlson's Comorbidity Index (CCI). Primary outcomes of study were length of stay (LOS) and cost of care (Cost). We ran survey regression model to find out predictors of length of stay and cost of care.Results:
Thirteen thousand five hundred eighty-seven (weighted number: 67,935) patients were admitted with Ulcerative Colitis nationwide. Mean age of patients was (47.6 ± 0.16) years. 52.27% were females and 71.68% were white. Patients with older age (LOS, 95% Confidence Interval, P- value) (+0.02 d, +0.02 to +0.02, P < 0.001), higher Charlson score (CCI-1: +0.44 d, +0.03 to +0.86, P = 0.034), (CCI-2: +1.18 d, +0.65 to +1.71, P < 0.001) compared to CCI-0, obesity (+0.31 d, +0.01 to +0.65, P = 0.04), heart failure (+1.15 d, +0.38 to +1.92, P = 0.003), peripheral vascular disease (+0.83 d, +0.18 to +1.48, P = 0.01), emergent admission (+1.03 d, +0.77 to +1.29, P < 0.001) compared to elective admission were associated with higher longer hospital stay. Hospital characteristics such as hospital teaching status (+1.11 d, +0.90 to +1.30, P <0.001), larger bed size hospitals (Large: +0.83 d, +0.56 to +1.11, P < 0.001) compared to small size. Patients with self-payment (−0.50, −0.81 to −0.19, P = 0.001) compared to Medicare/Medicaid had shorter length of stay. As far as cost is concern, Older age patients (Cost, 95% confidence interval, P-value) (+120 USD, +62 to + 178, P < 0.001), patient with higher Charlson Score (CCI-1, +1009 USD, +1479 to +11,539, P < 0.001), (CCI-2, +13,886 USD, +8505 to +19,266, P < 0.001), obesity (+5011 USD, 1686–8335, P = 0.003), heart failure (+11,415 USD, +3182 to +19,648, P = 0.006), peripheral vascular disease (+8294 USD, +2461 to +14,126, P = 0.005), emergent admission (+18,845 USD, +116,337 to +121,353, P < 0.001) compared to elective were associated with higher cost of care. Hospital characteristics such as higher bed size of hospital (Large: +9740 USD, +6589 to +12,891, P < 0.001) compared to small bed size and hospital teaching status (+12,019 USD, +9791 to +14,247, P < 0.001) compared to non-teaching. Non influential co morbidities were hypertension, diabetes, chronic lung disease, arthritis, liver disease, alcohol abuse.Conclusions:
We identify multiple patient and hospital level characteristics influencing length of stay and cost of care of Ulcerative Colitis patients. Additional intervention would require to decrease disparity in resource utilization amongst different kind of hospitals. Patient with higher resource utilization can be identified and can be intervened to reduce utilization of resources.