S5 Characteristics and Outcomes of Patients With IBD Admitted to High vs Low Safety Net Burden Hospitals: A Nationwide Analysis

Abstract

Background: Inflammatory bowel disease (IBD), is a chronic relapsing inflammatory disorder that requires a meticulous multidisciplinary management approach. This may prove difficult in safety net hospitals, and it is unclear if a hospital’s safety net burden (SNB) is associated with outcomes. The aim of this study was to investigate the effect of hospital SNB on in-hospital mortality, length of stay, and hospitalization cost in patients with IBD. Methods: We used the National Inpatient Sample (NIS) to identify all adult hospitalizations with IBD from 2016 to 2018. SNB was calculated as the percentage of hospitalizations with Medicaid or uninsured payer status for each hospital in the 2016-2018 database. Multivariable models were used to compare outcomes of admissions to hospitals with low SNB (lowest tertile, <18.1%) hospitals with high SNB (highest tertile, >31.1%). Results: The demographic and clinical characteristics for the 106,603 patients hospitalized with IBD are shown in Table 1 (see poster). Of all patients, 42.3% were admitted to low SNB hospitals and 57.7% were admitted to high SNB hospitals. The main study outcomes (in-hospital mortality, length of stay, and cost) are shown in Table 2 (see poster). In-hospital mortality was 1.4% in low SNB hospitals and 1.6% in high SNB hospitals (adjusted OR = 1.15, 95% CI 1.03-1.29, P = 0.016). Mean length of stay was longer in high SNB hospitals compared to low SNB hospitals (5.6 vs 5.1 days, adjusted mean difference 0.38 days, P < 0.0001). Low SNB hospitals had higher hospitalization costs compared to high SNB hospitals ($15,968 vs $15,670, adjusted mean difference $402, P = 0.01). Conclusion(s): In this large population of inpatients with IBD, patients admitted to high SNB hospitals had overall worse hospital mortality and longer length of stay. Patients admitted to low SNB hospitals had higher hospital costs. Further research is needed to clarify the cause of these discrepant outcomes in IBD hospitalizations, and specific interventions are needed to improve the delivery of care to IBD patients in high SNB hospitals.