Tu1075 The Impact of a Value-Based Health Program for Inflammatory Bowel Disease Management on Healthcare Utilization

Abstract

is cardiovascular disease for which antiplatelets and anticoagulants are prescribed. Thus, baby boomers are at risk of gastrointestinal bleeding (GIB) related to both pharmacologic exposure and advancing age. In 2012, the cost of GIB care was estimated at >$2.5 billion; half of which was billed to Medicare. Quantifying health care utilization of current baby boomers with GI bleeding will assist policy makers to forecast impact of this generation on future health care resource needs. Methods: A retrospective cohort study using 5 years of the Nationwide Inpatient Sample (2007-2011) was conducted to identify temporal trends in non-variceal, upperand lower-GIB to assess impact of age, co-morbidity, early vs. late endoscopy, transfer status, and disposition on the outcomes of hospital length of stay, 30day mortality and economic outcomes (charge). Temporal trends were evaluated using the Cochrane-Armitage test. The Chi-square test and multivariable linear regression models were used to quantify the impact of exposures of interest and potential effect modifiers on hospital length of stay and charge. Results: From 2007 to 2011 there were 1,322,122 hospital visits associated with GIB in 18,259,654 patients >50 years. Three-quarters of admissions were emergent, 19% occurred on the weekend and 51% were lower GIB. Overall prevalence was 7.2%, with an average length of stay (LOS) of 5.5 days (SD: 6.1) in 2007 that decreased to 5.1 days (SD: 5.7) by 2011 (p<0.001). A 1.4 day (95% CI: 1.31-1.44) increase in LOS was observed among patients ≥70 with a Charlson co-morbidity score ≥2. In-hospital mortality decreased over time from 2.5% to 2.0% (p<0.001). Total hospital charge increased over time from $29,602 (2007) to $38,549 (2011), p<0.001. Medicare or Medicaid was the primary payer in 39%. Primary drivers of the attributable charge (per admission) included age ≥70 years with a Charlson co-morbidity score ≥2 ($6,068; 95% CI: $5,796-$6,339); a transfer from another acute care facility ($15,429; 95% CI: $14,922-$15,937) and late endoscopy performed following a weekend admission ($5,784; 95% CI: $5,142-$6,425). Conclusions: The size, demographic composition and associated co-morbidities of this population have significant implications for health resource utilization, cost of care and third-party payers. Future study of alternative models of care and/or GIB reimbursement strategies is necessary to inform how to navigate the growing economic and health resource burden associated with this population.