(P014) SOCIOECONOMIC FACTORS AFFECTING LINKAGE TO CARE RATES IN INFLAMMATORY BOWEL DISEASE AT A TERTIARY REFERRAL CENTER

The incidence of inflammatory bowel disease (IBD) is rising among racial and ethnic minorities worldwide, and studies have shown that social determinants of health impact disparities in IBD outcomes. There is a paucity of data on the impact of social determinants of health on outcomes for IBD patients transitioning from inpatient to outpatient care. The aim of our study is to quantify the linkage to care rates for IBD patients from the inpatient to the outpatient setting and to analyze the socioeconomic factors that affect linkage to care. 

A retrospective cohort review was conducted of all patients admitted to a tertiary academic hospital (Emory University Hospital) for a moderate to severe ulcerative colitis or Crohn’s disease flare from 01/01/2020 to 12/31/2022. We included patients who were presenting for the first time with a flare or complication of IBD, or who had not yet been linked to outpatient IBD care. We excluded patients who were already established in IBD clinic. We collected patients’ demographic information, admission data, and outpatient IBD follow-up. We linked each patient’s address to that geographic area’s deprivation index (ADI), a measure of socioeconomic disadvantage for a particular region as outlined by U. of Wisconsin Center for Health Disparities Research. Descriptive statistics and univariate/multivariate regression were performed. 

In our cohort of 444 patients admitted with IBD flare or complication, 30 patients met inclusion criteria. This population was 60% female/40% male. 70% had CD, 23.3% had UC, and 6.7% had indeterminate IBD. 43.3% of this group were linked to outpatient follow-up and treatment after discharge. In univariate analysis, patients who were not linked to care had a higher state and national ADI (p=0.049, 0.029). Patients not linked to care were also less likely to have an appointment scheduled at the time of hospital discharge, less likely to have MyChart/Cerner portal access and more likely to have Medicare (p=0.0003, 0.03, 0.02). Male patients were less likely to be linked to care in both univariate analysis (p=0.02) and in logistic regression, when controlling for most other study variables (p=0.01-0.03).   

New IBD patients living in relatively socioeconomically deprived neighborhoods were significantly less likely to be linked to care after discharge. Other social determinants of health that influenced outpatient follow-up included having private insurance and access to remote electronic medical record use. Male patients are especially vulnerable to missing IBD follow-up, even when controlling for most other variables. The most influential factor in ensuring linkage to care in this population was having a follow-up scheduled prior to discharge, emphasizing that inpatient GI teams should proactively communicate with outpatient IBD clinics to link at-risk patients to future care.