Published online May 7, 2019. doi: 10.3748/wjg.v25.i17.2122
Peer-review started: January 18, 2019
First decision: January 30, 2019
Revised: February 5, 2019
Accepted: February 22, 2019
Article in press: February 23, 2019
Published online: May 7, 2019
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.
There is limited data on the types of hospital services accessed by patients with IBD and the frequency and location of hospital encounters. Identification of patterns of hospital care can guide inter-hospital data-sharing and care coordination which may improve continuity of care for these patients.
This study aimed to identify and quantify the hospital services accessed by patients with IBD in England.
This retrospective observational study used Hospital Episode Statistics, a large administrative dataset in National Health Service in England, to identify characteristics of hospital care encounters for IBD patients. The proportion of encounters with providers other than the patients usual ‘home provider’ of IBD care was calculated, in addition to associations with patient age, location and type of specialist providers attended.
The proportion of encounters with hospitals other than the usual gastroenterology ‘home provider’ for 95055 IBD patients was up to 26.7% for accident and emergency encounters, followed by 16.9% for outpatient and 12.2% for inpatient encounters. Patients living in cities and younger patients were less likely to attend their ‘home provider’ for hospital services. The most commonly attended outpatient specialty services were gastroenterology, general surgery and ophthalmology.
Up to one in four accident and emergency encounters for patients with IBD in England were with a different provider to the patient’s usual gastroenterology ‘home provider’ of IBD care. IBD patients also often attended other hospitals for a range of outpatient and inpatient services. These findings emphasise the importance of developing effective data-sharing strategies between hospitals to maintain continuity of information and continuity of care for IBD patients.
Findings from this study provide a national-level view of transitions of care between hospitals for patients with IBD in England. We have shown that certain groups of patients, including younger patients and those based in metropolitan areas, have more frequent transitions of care and may be a suitable target for further research and interventions to improve care continuity. Further qualitative and quantitative research is needed to understand the implications of these findings and improve inter-hospital data-sharing.