Sa1296 Emergent Gastrointestinal Diagnosis and Procedures: A Nationwide Longitudinal Study of Emergency Department and Inpatient Stays

Abstract

Background Emergent gastrointestinal (GI) diseases play a substantial role in driving healthcare costs. However, previous studies have not quantified longitudinal trends in GI disease care. Anecdotal evidence suggests that more acute cases of GI diseases and procedures have increased dramatically, perhaps due to economic factors and less access to preventive outpatient care. Aim To identify longitudinal profiles of GI-emergency department (ED) visits, inpatient stays and pertinent GI procedures using nationwide data. Method Our analysis of Healthcare Cost and Utilization Project (HCUP) nationwide data is designed to quantify recent patterns in gastrointestinal diagnoses and procedures. This cross-sectional longitudinal study uses data from HCUP: National Inpatient Sample (NIS) from 2000-2011 and Nationwide Emergency Department Sample (NEDS) from 2006 to 2010. ICD-9-CM diagnosis and procedure codes were analyzed. We tested for trends across the study period and normalized as needed. The average charge per gastrointestinal diagnosis and procedures were analyzed and adjusted for inflation. Logistic regressionwas used to analyze ED diagnoses. Results Figure 1 shows total number of ED visits from diagnostic codes of seven GI diseases (GI hemorrhage, gallstones, gastritis & duodenitis, abdominal pain, functional disorders, impaction, nausea and vomiting) between 2006 and 2010 and percent of patients with private insurance (black fill) versus other payment (grey fill). GI-ED diagnoses per capita increased, R2=.94, while percent of privately insured patients decreased. The total number of GI procedures per capita, (endoscopycontrol of gastric hemorrhage, endoscopysphincterotomy, endoscopyremoval of bile duct stone, and hemorrhoid ligation) increased between 2006 and 2010 with an R2=.71. Table 1 shows a higher average charge when a GI procedure was performed compared with average charge per GI-ED visit that resulted in admission and average charge per inpatient visit, though all three trend up. Also, a greater percentage of GI inpatients were admitted from the ED in 2010 compared to 2006. Limitations Patient data for NEDS and NIS are not linked; thus, summarized total counts are not consistent across the two data sources. Conclusions ED visits with seven gastrointestinal diseases as the primary diagnoses increased from 2006 to 2010. The increase in ED use for GI diseases coincides with a decrease in percentage of privately insured patients from 2008 to 2010. In addition, from 2006 to 2010 a greater percentage of GI-inpatients were admitted from the ED. Inpatient GI procedures mirrored upward trends with inpatient GI diagnoses. These three trends suggest that the 2008 US economic recession may have played a role in the observed greater percentage of GI patients admitted from the ED, with subsequent increase in charges per admission. Table 1