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Examining predictors of healthcare utilization in youth with inflammatory bowel disease

Wojtowicz, Andrea A.; Plevinsky, Jill M.; Poulopoulos, Natasha; Schurman, Jennifer V.; Greenley, Rachel N.

European Journal of Gastroenterology & Hepatology: April 2016 - Volume 28 - Issue 4 - p 469–474
doi: 10.1097/MEG.0000000000000540
Original Articles: Inflammatory Bowel Disease

Background and aims Traditional definitions of healthcare utilization (HCU) emphasize clinical visits and procedures. Clinic calls, an understudied form of HCU, occur with high frequency. Understanding and examining predictors of HCU, such as disease activity and parent distress, may help reduce overutilization.

Methods A total of 68 adolescents with inflammatory bowel disease [IBD; mean (SD) =14.18 (1.92) years] and their parents participated. Parent distress was assessed through parent report on the PedsQL Family Impact Module, and physicians provided ratings of patient disease activity using the Physician's Global Assessment index. Medical record reviews yielded HCU and clinic call information for 12 months after enrollment. HCU was operationalized as the total number of routine and sick gastrointestinal clinic visits, Emergency room visits, and IBD-related hospitalizations. A call composite reflected the total number of calls related to IBD symptoms/illness.

Results Disease activity and parent distress predicted 12% of the variance in calls and 12% of the variance in HCU. Disease activity was the only significant predictor of clinic calls after accounting for the impact of other predictors; however, parent distress was the only individual variable that contributed significant variance to the prediction of HCU after accounting for other predictors.

Conclusion Greater parent distress and disease activity together predicted HCU and clinic calls. Disease activity was the most salient predictor of calls, whereas parent distress was the most salient predictor of in-person HCU. Clinic calls should not be overlooked as a form of HCU, as communication that takes place outside of scheduled appointments utilizes resources and may indicate poorer disease control.

aDepartment of Psychology, Rosalind Franklin University of Medicine and Science, Chicago, Illinois

bDepartment of Developmental & Behavioral Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri, USA

Correspondence to Andrea A. Wojtowicz, MS, Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA Tel: +1 847 578 8751; fax: +1 847 578 8765; e-mail:

Received September 22, 2015

Accepted October 30, 2015

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