Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2019; 25(17): 2122-2132
Published online May 7, 2019. doi: 10.3748/wjg.v25.i17.2122
Transitions of care across hospital settings in patients with inflammatory bowel disease
Leigh R Warren, Jonathan M Clarke, Sonal Arora, Mauricio Barahona, Naila Arebi, Ara Darzi
Leigh R Warren, Sonal Arora, Ara Darzi, Patient Safety Translational Research Centre, Imperial College London, London W2 1NY, United Kingdom
Leigh R Warren, Jonathan M Clarke, Sonal Arora, Ara Darzi, Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
Jonathan M Clarke, Mauricio Barahona, Centre for Health Policy, Imperial College London Centre for Mathematics of Precision Healthcare, Imperial College London, London SW7 2BX, United Kingdom
Jonathan M Clarke, Department of Biostatistics, Harvard University, Boston, MA 02115, United States
Mauricio Barahona, Department of Mathematics, Imperial College London, London SW7 2BX, United Kingdom
Naila Arebi, Department of Gastroenterology, St. Marks Academic Institute, Harrow HA1 3UJ, United Kingdom
Author contributions: Warren LR, Clarke JM, Arora S, Arebi N and Darzi A contributed to study conception and design; Warren LR, Clarke JM, contributed to data acquisition and writing of article; Warren LR, Clarke JM, and Barahona M contributed to data analysis and interpretation; Barahona M contributed to editing of article; Arora S, Arebi N, Darzi A and Barahona M contributed to review and final approval of article.
Supported by grants fromthe National Institute for Health Research (NIHR) Imperial Patient Safety and Translational Research Centre (PSTRC) and the Peter Sowerby Foundation. Infrastructure support for this research was provided by the NHIR Imperial Biomedical Research Centre (BRC). MB acknowledges support from EPSRC [grant number EP/N014529/1] supporting the EPSRC Centre for Mathematics of Precision Healthcare. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.
Institutional review board statement: This study received local ethical approval through the Imperial College Research Ethics Committee [17IC4178].
Informed consent statement: This study used administrative data that was not identifiable. Informed consent was not applicable.
Conflict-of-interest statement: There are no financial conflicts of interest declared by the authors.
Data sharing statement: HES data are available on application to the NHS Digital (https://digital.nhs.uk).
STROBE statement: This study followed the guidelines of the STROBE statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Leigh R Warren, MBBS, Clinical Research Fellow, Surgeon, Department of Surgery and Cancer, Imperial College London, St. Mary’s Campus, Norfolk Place, London W2 1NY, United Kingdom. leigh.warren@imperial.ac.uk
Telephone: +44-2075895111 Fax: +44-2033126309
Received: January 17, 2019
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
Processing time: 109 Days and 4.9 Hours
ARTICLE HIGHLIGHTS
Research 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.

Research motivation

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.

Research objectives

This study aimed to identify and quantify the hospital services accessed by patients with IBD in England.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.