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Fragmented Care is Prevalent among Inflammatory Bowel Disease Readmissions and is Associated with Worse Outcomes

The American Journal of Gastroenterology (2018) | Download Citation




Inflammatory bowel disease (IBD) is a complex chronic disease that often requires a multispeciality approach; thus, IBD patients are prone to care fragmentation. We aim to determine the prevalence of fragmentation among hospitalized IBD patients and identify associated predictors and visit-level outcomes.


The State Inpatient Databases for New York and Florida were used to identify 90-day readmissions among IBD inpatients from 2009 to 2013. The prevalence of fragmentation, defined as a readmission to a non-index hospital, was reported. Characteristics associated with fragmented care were identified using multivariable logistic regression. Multivariable models were utilized to determine the association between fragmentation and outcomes (in-hospital mortality, readmission length of stay, and inpatient colonoscopy).


Among IBD inpatients, 25,241 and 29,033 90-day readmission visits were identified, in New York and Florida, respectively. The prevalence of fragmentation was 26.4% in New York and 32.5% in Florida. Younger age, a non-emergent admission type, public payer or uninsured status, mood disorder, and substance abuse were associated with fragmented care, while female gender and a primary diagnosis of an IBD-related complication had an inverse association. Fragmented inpatient care is associated with a higher likelihood of in-hospital death, higher rates of inpatient colonoscopy, and a longer readmission length of stay.


Over one in four IBD inpatient readmissions are fragmented. Disparities and differences in fragmentation exist and contribute to poor patient outcomes. Additional efforts targeting fragmentation should be made to better coordinate IBD management, reduce healthcare gaps, and promote high-value care.

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Author information


  1. Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, MI, 48109, USA

    • Shirley Cohen-Mekelburg MD, MS
    • , Akbar K. Waljee MD, MSc
    •  & Sameer Saini MD, MSc
  2. Division of Gastroenterology & Hepatology, New York Presbyterian Weill Cornell Medicine, New York, NY, 10021, USA

    • Russell Rosenblatt MD, MS
    • , Nicole Shen MD
    • , Brett Fortune MD, MSc
    • , Ellen Scherl MD
    •  & Robert Burakoff MD, MPH
  3. Department of Medicine, New York Presbyterian Weill Cornell Medicine, New York, NY, 10021, USA

    • Stephanie Gold MD
  4. Department of Healthcare Policy & Research, New York Presbyterian Weill Cornell Medicine, New York, NY, 10021, USA

    • Mark Unruh PhD
  5. VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, 48105, USA

    • Akbar K. Waljee MD, MSc
    •  & Sameer Saini MD, MSc
  6. Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI, 48109, USA

    • Akbar K. Waljee MD, MSc


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Guarantor of the article

Shirley Cohen-Mekelburg, MD, MS.

Specific author contributions

Shirley Cohen-Mekelburg, Russell Rosenblatt, Stephanie Gold, and Mark Unruh were involved in the study concept and design, data management, statistical analysis and interpretation of data, drafting of manuscript, and critical revisions. In addition, Shirley Cohen-Mekelburg and Mark Unruh were involved in study supervision. Brett Fortune, Ellen Scherl, Robert Burakoff, Akbar K. Waljee, and Sameer Saini were involved in interpretation of data and critical revisions. All authors approved the final version of the article, including the authorship list

Financial support


Potential competing interests

ES has received grant/research support from Abbott Laboratories (AbbVie), AstraZeneca, Janssen Research & Development, and Pfizer, and serves as a consultant to AbbVie, Janssen Pharmaceutical, and Takeda Pharmaceuticals. The remaining authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Shirley Cohen-Mekelburg MD, MS.



Table 3 and 4

Table 3 List of the International Classification of Diseases, Ninth revision, Clinical modification (ICD-9-CM) diagnostic and procedure codes
Table 4 Factors associated with fragmentation in care among all cause IBD-related 30-day readmissions

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