Transitions of care across hospital settings in patients with inflammatory bowel disease

Abstract

Background: Inflammatory bowel disease (IBD) is a chronic, inflammatory disorder characterised by both intestinal and extra-intestinal pathology. Patients may receive both emergency and elective care from several providers, often in different hospital settings. Poorly managed transitions of care between providers can lead to inefficiencies in care and patient safety issues. To ensure that the sharing of patient information between providers is appropriate, timely, accurate and secure, effective data-sharing infrastructure needs to be developed. To optimise inter-hospital data-sharing for IBD patients, we need to better understand patterns of hospital encounters in this group.

Aim: To determine the type and location of hospital services accessed by IBD patients in England.

Methods: This was a retrospective observational study using Hospital Episode Statistics, a large administrative patient data set from the National Health Service in England. Adult patients with a diagnosis of IBD following admission to hospital were followed over a 2-year period to determine the proportion of care accessed at the same hospital providing their outpatient IBD care, defined as their 'home provider'. Secondary outcome measures included the geographic distribution of patient-sharing, regional and age-related differences in accessing services, and type and frequency of outpatient encounters.

Results: 95055 patients accessed hospital services on 1760156 occasions over a 2-year follow-up period. The proportion of these encounters with their identified IBD 'home provider' was 73.3%, 87.8% and 83.1% for accident and emergency, inpatient and outpatient encounters respectively. Patients living in metropolitan centres and younger patients were less likely to attend their 'home provider' for hospital services. The most commonly attended specialty services were gastroenterology, general surgery and ophthalmology.

Conclusion: Transitions of care between secondary care settings are common for patients with IBD. Effective systems of data-sharing and care integration are essential to providing safe and effective care for patients. Geographic and age-related patterns of care transitions identified in this study may be used to guide interventions aimed at improving continuity of care.

Keywords: Continuity of care; Crohn’s disease; Fragmentation; Inflammatory bowel disease; Multi-morbidity; Transitions of care; Ulcerative colitis.

Figure 1

Proportion of accident and emergency, inpatient and outpatient presentations to inflammatory bowel disease care ‘home provider’ by Middle Layer Super Output Area of residence.

Figure 2

Distribution of 20 highest and 20 lowest providers per proportion of encounters with home provider (from 144 included providers).

Figure 3

Proportion of ‘home provider’ encounters per age for three age bands, <40, 40-70 and > 70 years.