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Patterns of healthcare utilization in post-operative Crohn's disease

Gajendran, Mahesh (2014) Patterns of healthcare utilization in post-operative Crohn's disease. Master Essay, University of Pittsburgh.

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Abstract

Background: Surgery rapidly induces remission in Crohn’s disease (CD) but patterns of clinical recurrence and healthcare utilization beyond 1 year have not been well characterized. CD is one of the most significant chronic gastrointestinal condition, that is associated with high morbidity and decreased quality of life. From a 2002 population based study Crohn's disease was found to affect about 400,000- 600,000 people in North America causing a significant public health burden and associated healthcare cost. Methods: Retrospective observational study of CD patients undergoing resection/anastomosis stratified by patterns of healthcare utilization during the two year follow-up: High Utilizer (HU) group who require CD related emergency department visit (ED), hospital admission (HA) or repeat bowel surgery (RS) in the 2 year post-operative period and Low Utilizer (LU) group who have none of these events. Results: There were 45 CD patients with resection and side-to-side anastomosis (49% males, age 40.5 years, 24.4% smokers, 33.3% previous resection, 62.2% laparoscopic). Within 2 years of surgery, 46.7% required abdominal CT scan (78 scans, 21 patients), 33.3% required ED evaluation (70 ED visits, 15 patients), 29% had HA (40 HA, 13 patients) and 6.7% had RS (3 surgeries, 3 patients). There were differences between the LU (N=30) and HU groups (N=15) in the rate of smoking (13% vs. 26%; p=0.02), presence of > 2 co-morbid medical conditions (3.3% vs. 46.7%; p=0.001), biologic use before surgery (23% vs. 60%; p=0.009), biologic use after surgery (13% vs. 47%; p=0.026) and post-operative steroid use ( 10% vs. 53%;p= 0.003). Inflammation on post-operative colonoscopy was identified in 24 % of patients (20% vs. 33%; p=0.4). Conclusions: In the 2 year post-operative period, 33% of patients required ED visit, 47% of patients warranted CT imaging for evaluation of abdominal pain, suggesting increased health care utilization in a subgroup of post-op patients with side-to-side anastomosis. In this era of increasing health care costs, from a public health standpoint, this study implies the need for effective treatment strategies to reduce IBD complications and related healthcare expenditure.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Gajendran, Maheshmag157@pitt.eduMAG157
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairFinegold, David Ndnf@pitt.eduDNFUNSPECIFIED
Committee MemberBinion, Davidbinion@pitt.eduBINIONUNSPECIFIED
Date: June 2014
Date Type: Publication
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Publisher: University of Pittsburgh
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Multidisciplinary MPH
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: Crohns, disease, Healthcare, utilization, Outcomes, bowel, resection
Date Deposited: 03 Nov 2014 21:46
Last Modified: 02 May 2019 14:56
URI: http://d-scholarship.pitt.edu/id/eprint/21388

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