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Telephone Encounters Predict Future High Financial Expenditures in Inflammatory Bowel Disease Patients: A 3-Year Prospective Observational Study

Click, Benjamin, MD; Anderson, Alyce, M., BS; Ramos Rivers, Claudia, MD; Koutroubakis, Ioannis, E., MD, PhD; Hashash, Jana, G., MD; Dunn, Michael, A., MD; Schwartz, Marc, MD; Swoger, Jason, MD; Barrie, Arthur, III, MD, PhD; Szigethy, Eva, MD, PhD; Regueiro, Miguel, MD; Schoen, Robert, E., MD, MPH; Binion, David, G., MD

Journal of Clinical Gastroenterology: April 2018 - Volume 52 - Issue 4 - p 319–325
doi: 10.1097/MCG.0000000000000801
ALIMENTARY TRACT: Original Articles

Background: Telephone activity is essential in management of complex chronic diseases including inflammatory bowel disease (IBD). Telephone encounters logged in the electronic medical record have recently been proposed as a surrogate marker of disease activity and impending health care utilization; however, the association between telephone calls and financial expenditures has not been evaluated.

Study: We performed a 3-year prospective observational study of telephone encounters logged at a tertiary referral IBD center. We analyzed patient demographics, disease characteristics, comorbidities, clinical activity, and health care financial charges by telephone encounter frequency.

Results: Eight hundred one patients met inclusion criteria (52.3% female; mean age, 44.1 y), accounted for 12,669 telephone encounters, and accrued $70,513,449 in charges over 3 years. High telephone encounter frequency was associated with female gender (P=0.003), anxiety/depression (P<0.001), and prior IBD surgery (P<0.001). High telephone encounter categories had significantly more hospitalizations (P<0.001), IBD surgery (P<0.001), worse quality of life (P<0.001), more corticosteroid (P<0.001), biological (P<0.001), and opiate prescriptions (P<0.001). High telephone encounter frequency patients amassed higher total available charges in each year (P<0.001) and over the 3 years (P<0.001). Telephone encounters in 2009 (P=0.02) and 2010 (P<0.001) were significantly associated with financial charges the following year after controlling for demographic, utilization, and medication covariates.

Conclusions: Increased telephone encounters are associated with significantly higher health care utilization and financial expenditures. Increased call frequency is predictive of future health care spending. Telephone encounters are a useful tool to identify patients at risk of clinical deterioration and large financial expense.

Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA

B.C. reports support from National Institutes of Health training grant 5T32DK063922-12 (PI: David Whitcomb, MD, PhD). A.M.A. is supported by the University of Pittsburgh Clinical and Translational Science Institute grant 5TL1TR000145-09 (PI: Steven E. Reis, MD). I.E.K. reports support by a sabbatical salary of Medical Faculty University of Crete, Greece. D.G.B. and M.A.D. report support from Grant W81XWH-11-2-0133 from the US Army Medical Research and Materiel Command.

B.C.: study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, statistical analysis, tables and figures production, and obtaining funding. A.M.A.: analysis and interpretation of data, drafting of the manuscript, tables, and figures production. C.R.R.: acquisition of data, analysis, critical revision of the manuscript, administrative, and technical support. I.E.K.: study concept and design, critical revision of manuscript, study supervision. J.G.H., M.A.D., M.S., J.S., A.B., E.S., and M.R.: critical revision of the manuscript. R.E.S.: study design, critical revision of the manuscript. D.G.B.: study concept and design, interpretation of data, drafting of the manuscript, critical revision of the manuscript, and study supervision.

The authors declare that they have nothing to disclose.

Address correspondence to: Benjamin H. Click, MD, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, M2, C-wing, 200 Lothrop Street, Pittsburgh, PA 15213 (e-mail:

Received June 5, 2016

Accepted December 8, 2016

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