AGA Abstracts data. Results: 357 patients contacted the IBD Helpline complaining of diarrhoea. 357 (100%) were sent stool pots for standard stool culture and CDT by post. Results were reviewed before deciding on further management. 300 (84%) patients completed the tests. Of these 15 (5%) were positive. 8 showed CDT, 6 Campylobacter and 1 Blastocystis hominis. 179 (99 male) IBD patients were admitted during the same 3 year period with symptoms of a flare. 122 patients had diarrhoea on admission. 96 (79%) underwent stool testing. 2 (2%) were positive for infection: 1 for campylobacter, 1 for CDT. Conclusion: These results demonstrate that enteric infection is a relatively common cause of disease flares and underlines the importance of screening for this. Unfortunately frequency of stool testing in our inpatient population falls below recommended standards. In contrast testing undertaken by our nurse- led IBD helpline met the standard. Tu1249 Telephone Activity in Inflammatory Bowel Disease Patients Predicts Future High Healthcare Expenditures: A 3-Year Prospective Study Benjamin H. Click, Claudia Ramos Rivers, Ioannis E. Koutroubakis, Jana G. Hashash, Michael A. Dunn, Arthur Barrie, Marc Schwartz, Jason M. Swoger, Leonard Baidoo, Miguel Regueiro, David G. Binion Background: Telephone activity is essential in management of complex chronic diseases including Inflammatory Bowel Disease (IBD). Telephone encounters logged in the electronic medical record (EMR) have recently been proposed as a surrogate marker of disease activity and may function as a marker of future healthcare utilization. The exact association between telephone encounters and financial burden of healthcare expenditure in IBD is unknown. Purpose: The aim of this study was to analyze healthcare charges in a cohort of IBD patients stratified by telephone encounter frequency. Methods: We performed a prospective observational study using a consented, natural history registry from a tertiary referral IBD center to categorize telephone encounters logged in the EMR by nursing staff from 2009 to 2011. Financial charge data was obtained for all registry patients. Charges were categorized as total summation ("Total"), inpatient admission charges ("Hospital"), and professional service charges ("Professional"). Professional service charges included surgery and related fees, endoscopies, radiology, pathology, laboratory testing, diagnostic tests or procedures, emergency department visits, sex-specific health care, and clinic visits. We compared financial charges by telephone encounter frequency. Results: We categorized telephone and finance data on 801 patients. Nearly a third called between 0 and 1 times (31.0%) or between 2 and 5 times (34.2%) while 20.0% patients logged 6-10 calls and 14.9% more than 10. There were significant differences in median total financial expenditures as well as professional charges between call frequency categories over the 3-year period (Table 1). Telephone encounter count over three years was significantly associated with total charges (p<0.0001) over the same period (Table 2). Furthermore, telephone encounters in 2009 were predictive of future expenditures in 2010 (p=0.002) and 2011 (p=0.001). Likewise, 2010 telephone frequency predicted charges in 2011 (p<0.0001). Conclusion: Increased telephone encounter frequency is associated with significantly higher healthcare spending and is also a significant predictor of future spending. These findings support the use of telephone encounters as a surrogate for disease activity. Table 1. Charge categories by frequency of telephone encounters. Table 2. Poisson regression of telephone call frequency to predict total and future expenditures (natural log transformed). S-836 AGA Abstracts Tu1250 What Is the Difference Between Crohn's Disease Admissions to a Tertiary Referral Center and a Community Hospital? Anwar Dudekula, Benjamin H. Click, Claudia Ramos Rivers, Jana G. Hashash, Michael A. Dunn, Arthur Barrie, Marc Schwartz, Jason M. Swoger, Leonard Baidoo, Miguel Regueiro, David G. Binion Background: Crohn's disease (CD) is a chronic gastrointestinal inflammatory disorder with heterogeneous clinical complexity ranging from mild to severe. High volume/expert centers will handle more complex cases compared with lower volume community hospitals, but the specific differences in these admissions and their patient characteristics has not been defined. We compared the clinical and cost characteristics of hospital admissions at a high volume tertiary referral center compared with lower volume community hospitals from a single region. Methods: A comprehensive administrative dataset for an 11 county region of a large U.S. state, which tracks de-identified patients was used for 2010. ICD9 codes identified primary CD admissions. Hospitals were stratified by annual primary CD admission volume: >150 (high vol.), and <50 (low vol.). High volume hospitals were designated "tertiary referral" and low volume centers were designated "community hospitals." Medium volume hospitals were excluded. Results: There was 1 tertiary referral center and 25 community hospitals identified and these facilities handled a total of 826 CD admissions which formed the study set. The tertiary referral center handled 307 admissions (37% of admissions) which were generated by 230 distinct patients while the 25 community hospitals handled 443 admissions (53.6% of admissions) generated by 361 distinct patients. The tertiary referral hospital generated a higher percentage of readmissions compared with the community hospitals ( 43.0% vs 30%; p <0.001). The patients at the tertiary referral hospital requiring readmission was 23% compared with 14% in the community hospitals (p<0.02). Mean length of stay in the tertiary referral hospital was 6.1 days (S.D. 4.7 days) which was significantly longer than the community hospital mean length of stay of 4.8 days (S.D. 3.8 days; p<0.001). There was a higher percentage of surgical admissions at the tertiary referral hospital compared with the community hospitals (47% vs 15%; p<0.001). The charges from the single referral hospital totaled $24.5 million, $18.0 million of which was associated with surgical admis- sions, while the 25 commmunity hospitals generated a $7.9 million total charge, of which $2.26 million was surgical. Comorbidities most commonly found in the tertiary referral hospital were intestinal obstruction 4.0%, GERD 3.0%, intestinal fistula 2.8% and peritoneal adhesions 2.8% while comorbidities associated with CD admissions to the community hospital included: hypertension 3.7%, tobacco use 3.5% GERD 3.1% and electrolyte abnor- malities 2.6%. Conclusions: CD admissions at a tertiary referral hospital demonstrate increased complexity, based on higher need for higher surgical intervention, longer hospital stays and overall costs compared with CD admissions handled in the community hospital set- ting. Table 1. Comparison of Community and Tertiary Hospitals Tu1251 The Financial Burden of Crohn's Disease Healthcare Expenditures: A Multi- Year Prospective Experience Benjamin H. Click, Claudia Ramos Rivers, Jana G. Hashash, Michael A. Dunn, Arthur Barrie, Marc Schwartz, Jason M. Swoger, Leonard Baidoo, Miguel Regueiro, David G. Binion Background: Crohn's disease (CD) is a chronic, lifelong inflammatory injury to the gastrointes- tinal tract and patients will demonstrate variable disease trajectories often requiring hospital care, expensive medications and invasive treatments. Prior studies investigating financial aspects of CD have examined the direct cost of the gastrointestinal disease while no studies have defined the exact financial burden of complete medical care for CD patients. The purpose of this study was to examine significant sources of monetary charges related to healthcare in CD patients. Methods: This was an observational study using a consented, prospective, natural history registry from a tertiary IBD center. CD patients with at least 3 consecutive years of follow up over a 5 year observation period formed the study population.