EP348 - Characterizing Patterns Of Care For Diverticulitis Within The Contemporary Health System

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Purpose/Background: Diverticulitis is the most common benign pathology of the colon, and imposes a large healthcare burden across outpatient care, hospital admissions and surgical costs. To help offload this burden, clinical practice guidelines (CPGs) have increasingly encouraged outpatient management of uncomplicated cases, judicious antibiotic use, and selective surgery. However, recent studies show increased admissions and elective operations for diverticulitis over time, suggesting a delay or gap between CPGs and reality. To understand where our patients are seeking care for diverticulitis and better identify areas that vary from CPG-concordant care, we aimed to prospectively capture patients presenting with diverticulitis in our health system, describe the treatment setting and provider, and characterize broad categories of treatment recommendations during the initial care.

Methods/Interventions: Patients with CT-confirmed diverticulitis were prospectively captured at a single institution between 2019 and 2020 to create this cohort. The CT setting was identified and the main treating provider for diverticulitis was categorized as medicine (including primary care, hospitalist, urgent care, and other outpatient subspecialties except gastroenterology [GI]), surgery (including colorectal), GI, or emergency medicine. Diverticulitis was categorized as uncomplicated or complicated (perforation, abscess, or fistula) based on CT findings. Patterns of antibiotic prescription, updated colonoscopy within a year of diverticulitis, and surgical referrals were characterized.

Results/Outcomes: Between 2019 and 2020, there were 310 patients (mean age 62 +/- 13 years, 60% female) with CT-confirmed diverticulitis. Of these, 223 patients (72%) had initial diagnoses of diverticulitis. 57 patients (18%) had evidence of complicated diverticulitis on CT. Most diagnoses were made in the outpatient setting (60% outpatient, 36.5% emergency department [ED], and 3.5% inpatient). Complicated cases were more likely to present to the ED (n=28, 25%) than outpatient (n=24, 13%, p=0.002). Antibiotics were prescribed in 91% of cases, and patients presenting to the ED were more likely to be prescribed antibiotics (96% ED vs. 88% outpatient vs. 91% inpatient, p=0.04, Figure 1A). Up-to-date colonoscopy between uncomplicated and complicated cases was not statistically significant (45% vs 56%, p=0.14, Figure 1B). Surgical referrals for diverticulitis occurred in 120 patients (39%, Figure 1C), with complicated diverticulitis (n=48, 84%) being more likely to be referred than uncomplicated cases (n=72, 29%, p< 0.001).

Conclusion/Discussion: Unsurprisingly, most episodes of diverticulitis are uncomplicated and occur in the outpatient setting. Regardless of presentation setting, care seems fragmented across multiple provider groups, making it difficult to measure appropriate delivery of CPG-concordant care for diverticulitis. The variation in care seen in this study suggests an opportunity for better management of diverticulitis at a system level, especially with evolving individualized treatment recommendations.