Examining the Consequences of Fragmented IBD Care

Treatment for inflammatory bowel disease often involves coordination among doctors and facilities. A new study finds there’s room for improvement.

7:00 AM

Author | Jina Sawani

More than 1.6 million Americans have inflammatory bowel disease, a complex chronic condition that often requires treatment from multiple specialists and facilities.

Such juggling can make IBD patients more susceptible to fragmented care, or a misalignment in care for their disease.

LISTEN UP: Add the new Michigan Medicine News Break to your Alexa-enabled device, or subscribe to our daily audio updates on iTunes, Google Play and Stitcher.

It's a scenario many providers know all too well.

"Nearly all physicians have experienced the frustration of treating a patient whose care has been dispersed among multiple institutions," says Shirley Ann Cohen-Mekelburg, M.D., M.S., a gastroenterologist and clinical lecturer at the University of Michigan.

"This poses significant barriers to collecting information related to lab and radiographic testing for IBD patients and can delay optimal care."

This notion inspired Cohen-Mekelburg and her research team to study the prevalence of health care fragmentation in the hospitalized IBD population — the first effort of its kind. The work was recently published in the American Journal of Gastroenterology.

IBD is a chronic disease that requires multispecialty care, underscoring the need for more integrated care among this population.
Shirley Ann Cohen-Mekelburg, M.D., M.S.

Examining a problem

To examine the issue, researchers looked at the Healthcare Cost and Utilization Project state inpatient databases for New York and Florida to identify 90-day readmission rates among IBD patients from 2009 to 2013.

"We defined the term 'fragmentation' as readmission to a nonindex hospital, or a hospital that is different from the hospital a patient was originally admitted to," Cohen-Mekelburg says.

MORE FROM THE LAB: Subscribe to our weekly newsletter

The data revealed significant differences in hospital fragmentation rates among IBD patients by age, primary payer, psychiatric comorbidity, admission type and the presence of an IBD-related complication.

Among all IBD patients, 90-day fragmentation rates were 26.4 percent in New York and 32.5 percent in Florida. State records showed 25,241 and 29,033 readmission visits, respectively.

About 53 percent of readmitted patients in both states were women, and a majority were white (81 percent in Florida and 77 percent in New York).

Additionally, 60 percent of individuals in both states were readmitted to a hospital for Crohn's disease, a subtype of IBD.

Key revelations and takeaways

Historically, fragmented care has been tied to poor patient outcomes and duplication in testing.

This study confirmed these ties and suggested links between fragmentation and higher in-hospital death rates, an increase in inpatient colonoscopies and longer readmission hospital stays.

The research team also observed a strong association between mental health disorders and fragmented care, specifically in people with mood disorders or substance abuse issues.

SEE ALSO: After Surgery, Where Hospitals Send Patients Makes a Big Difference

"As researchers, our goal was to better understand the scale of hospital fragmentation as a first step towards improving coordination efforts among physicians for IBD patients," Cohen-Mekelburg says.

Multiple variables contribute to health care fragmentation, including issues at the patient, provider and system levels.

On the other hand, fragmentation also probably affects the adequacy of chronic disease care. For example, fragmentation may contribute to inadequate mental health care delivery and therefore poorly controlled psychiatric comorbidities, which are strongly tied to fragmentation in this study.

Although the availability of mental health resources is limited nationally, addressing barriers to psychiatric care access could also help target fragmentation in IBD care, Cohen-Mekelburg says.

Further, patients who are hospitalized for IBD-related complications without psychiatric issues have lower proportions of fragmented readmission rates. It is hypothesized that while patients with IBD-related complications may have the most medically complex disease, they have lower rates of fragmentation because of their many outpatient visits.

This suggests that unlike psychosocial determinants, the burden of disease severity is not a main contributor to fragmented care.

"Overall, this study revealed a lot," Cohen-Mekelburg says. "Over 1 in 4 IBD inpatient readmissions are fragmented, and substantial disparities and differences in fragmentation exist. IBD is a chronic disease that requires multispecialty care, underscoring the need for more integrated care among this population.

"Therefore, gastroenterologists must call attention to the importance of coordination in IBD care, and this study highlighted that."

More Articles About: Industry DX Inflammatory Bowel Disease (IBD) Health Care Quality Health Care Delivery, Policy and Economics Digestive (GI) Conditions
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories Frustrated military patient talking with doctor
Health Lab
Fragmented Care and IBD: Outcomes in U.S. Veterans
New research in veterans shows IBD outcomes suffer as a result of fragmented care.
Illustration of girl with blue water line, depicting a figure drowning, as girl contemplates pill in hand
Health Lab
Antidepressant dispensing to adolescents and young adults surges during pandemic
Rate of antidepressant dispensing to young people rose faster after March 2020, especially among females
Scale pictured behind a hospital room curtain
Health Lab
Obesity care can make a big difference, but few get it, study suggests
Obesity care under a health care provider’s supervision, whether through nutrition counseling, medication, meal replacement or bariatric surgery, can help people with high BMI, but many don’t receive it.
Woman in pink shirt lifts kettleball in an outdoor exercise class
Health Lab
How to make cancer prevention more equitable
Expert explains six behavioral risk factors for cancer and why current programs don’t always meet the needs of people from racially and ethnically minoritized groups and other vulnerable populations.
Dark staircase leading to blue sky above
Health Lab
Ketamine’s promise for severe depression grows, but major questions remain
New findings about the impact of IV ketamine on treatment resistant depression add more fuel to the potential for broader use and insurance coverage.
A dentist operates on a patient at Exalta Health in Grand Rapids
Health Lab
Using telehealth to serve disparate populations
A collaboration between Exalta Health and University of Michigan Health-West is a creative method of bridging language, financial, and technology gaps between patients and health care providers.