Variation in healthcare utilisation amongst IBD care centres in Australia and New Zealand, Crohn's Colitis Care Data Insight's Program.

Abstract

Background: Inflammatory bowel disease (IBD) is a global health issue with Australia (AUS) and New Zealand (NZ) having amongst the highest prevalence rates worldwide. Due to a paucity of externally visible data on how care is delivered within individual sites, little is known about utilisation of various care inputs and the presence and/or magnitude of any variation in this amongst centres. We therefore examined the use of various documented care inputs amongst 11 Australasian IBD centres over a 12-month period. Method(s): Crohn's Colitis Care (CCCare) is a cloud-based IBD-specific electronic medical record (EMR) used in Australasia. Deidentified data prospectively entered by clinicians and consumers during routine clinical practice from September 2023 to September 2024 were retrospectively analysed. Centres with over 100 people with IBD with an assessment during the last 14-month period were included. Result(s): A total of 7119 eligible people with IBD from 11 centres were included; of those, 55.9% (n=3982) had Crohn's Disease, 41.3% (n=2938) had Ulcerative Colitis, and 2.8% (n=199) had IBD-Unclassified. There was an even gender distribution with 49.3% (n=3508) male, 48.0% (n=3420) female; 2.8% (n=199) did not have gender documented. Most resided in AUS (71.9%, n=5120) and 28.1% (n=1999) in NZ. Their median age was 42 years (IQR 31 - 57), and the median disease duration was 10.8 years (IQR 5.2 - 19.2). The number of eligible people with IBD included per centre ranged from 165 to 1421 (median 729, IQR 350 - 805). A total of 10,910 clinical assessments (in-person and telehealth) were conducted and documented in CCCare; with centre variation from 1.0 per person (pp) to 2.4 pp (p<0.001). Nine centres documented Helpline contacts which varied from 0.0 pp to 7.8 pp (p< 0.001). The number of endoscopies performed varied from 0.2 pp to 0.5 pp (p<0.001) and the number of radiological investigations performed varied from 0.0 pp to 0.8 pp (p<0.001). Admission rates across the sites were similar, ranging from 0.0 pp to - 0.1 pp (p=0.88). Conclusion(s): There was significant variation in healthcare utilisation across 11 IBD centres in AUS and NZ. Despite large variation in rates of radiology and endoscopy, admission rates did not differ, suggesting that, at least in the short term, greater use of these resources did not improve outcomes at cohort level. Further analyses are required to understand this variability, which may include specific patient needs, site-specific practices, or differences in access to healthcare services and resources. A tool like CCCare, is key to enabling health services research across centres and will support us with data to develop evidence-based IBD care guidelines to achieve equitable, cost-effective care.