Telephone Calls to IBD Clinics Predict Future Hospitalizations

Telephone surveillance can help doctors identify patients with severe inflammatory bowel disease (IBD) and those at risk of potentially avoidable high-cost medical interventions, according to a new study.

Researchers at the University of Pittsburgh (Pitt, PA, USA) conducted a prospective observational study in which they analyzed two years of telephone activity at an IBD care center and categorized the calls received by nursing staff. In all, they analyzed data on 21,979 ingoing and outgoing calls in 2009 and 32,667 calls in 2010, and assessed associations between clinical factors and logged telephone encounters, and between patterns of telephone encounters and future visits to the emergency department (ED) or hospitalization.

The results showed that telephone encounters occurred twice as frequently as office visits. In all, just 15% of the patients generated high telephone encounters (THEs, more than 10 per year), and were responsible for half of all telephone encounters. A higher percentage of these patients were female, had Crohn's disease, received steroid treatment, had increased levels of C-reactive protein (CRP) and erythrocyte sedimentation rates, suffered from psychiatric comorbidities, and had chronic abdominal pain than patients with lower telephone encounters.

The results showed that HTE patients were also more frequently seen in the ED or hospitalized over the same time period and in subsequent years; in fact, 42% of patients with more than eight telephone encounters during a period of 30 days were seen in the ED or hospitalized within the subsequent 12 months. The study was published online ahead of print on November 19, 2013, in Clinical Gastroenterology and Hepatology.

“Telephone surveillance and the use of big data allowed us to find red flags identifying patients at risk of high-cost medical interventions, such as emergency department use and/or hospitalization,” said senior author Prof. David Binion, MD, co-director of the Pitt IBD Center. “These findings can help to identify disease severity and teach us how to take better care of our patients.”

“We believe we will ultimately be able to use this information to prevent hospitalization, since we now have better insight into the heterogeneous factors which are getting our patients into trouble,” added Dr. Binion. “Our next step is to set up an intervention trial, where patterns of telephone activity will be used as an early warning strategy to identify at-risk patients.” 

IBDs (which include mainly Crohn's disease and ulcerative colitis) are chronic lifelong conditions that affect millions worldwide, the majority of whom are diagnosed as young adults. Telephone communication in IBD care is common, and involves reporting clinical status, treatment given, patient reassurance, and the completion of health care forms and insurance authorizations. 

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