{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T19:01:36Z","timestamp":1790794896970,"version":"4.1.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Children with inflammatory bowel disease (IBD) require substantial health care engagement, yet traditional utilization metrics underestimate the scope of care by omitting between-visit clinical activity such as electronic messaging, telephone encounters, and results review. Pediatric-specific data describing this hidden workload remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective longitudinal cohort study of youth aged 0 to 22 years diagnosed with IBD between 2015 and 2024 at a tertiary care center. Eligible patients had\u2009\u2265\u20096\u2009months of primary care prior to diagnosis and\u2009\u2265\u20096\u2009months of gastroenterological follow-up postdiagnosis. From the shared electronic health record, we quantified outpatient visits, emergency care, and procedures, as well as between-visit care (portal messages from patients, telephone encounters, and clinician-patient review of results) from prediagnosis through long-term follow-up. Events were aggregated into 6-month epochs relative to diagnosis and stratified by disease severity using validated symptom indices. Predictors of between-visit care were evaluated using generalized linear mixed-effects modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 226 patients (median age 12\u2009years; 57% male), health care utilization increased markedly during peri-diagnostic epochs. Between-visit care rose from a median of 1 event per 6\u2009months\u2009&amp;gt;\u20091\u2009year prediagnosis to 64 events in the year following diagnosis, and the number of these events remained persistently elevated thereafter. Higher disease severity was strongly associated with increased between-visit care. In multivariable analysis, postdiagnosis epochs, moderate-severe disease activity, and later diagnostic year independently predicted increased between-visit care (all P\u2009&amp;lt;\u2009.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Between-visit care represents a substantial and clinically meaningful component of pediatric IBD management, underscoring the need for workforce planning, reimbursement models, and digital innovations to address this largely invisible clinical workload.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ibd\/izag097","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T11:48:09Z","timestamp":1778845689000},"page":"1949-1956","source":"Crossref","is-referenced-by-count":2,"title":["Between-visit care represents a substantial and underrecognized component of health care utilization in pediatric inflammatory bowel disease"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2742-5557","authenticated-orcid":false,"given":"Jeannie S","family":"Huang","sequence":"first","affiliation":[{"name":"Divisions of Gastroenterology, Hepatology, and Nutrition, Rady Children\u2019s Hospital , San Diego, CA 92123,","place":["United States"]},{"name":"Clinical Informatics, Rady Children\u2019s Hospital , San Diego, CA 92123,","place":["United States"]},{"name":"Department of Pediatrics, University of California San Diego , La Jolla, CA 92093,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura E","family":"Bauman","sequence":"additional","affiliation":[{"name":"Divisions of Gastroenterology, Hepatology, and Nutrition, Rady Children\u2019s Hospital , San Diego, CA 92123,","place":["United States"]},{"name":"Department of Pediatrics, University of California San Diego , La Jolla, CA 92093,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Katibian","sequence":"additional","affiliation":[{"name":"Divisions of Gastroenterology, Hepatology, and Nutrition, Rady Children\u2019s Hospital , San Diego, CA 92123,","place":["United States"]},{"name":"Department of Pediatrics, University of California San Diego , La Jolla, CA 92093,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Brent","family":"Polk","sequence":"additional","affiliation":[{"name":"Divisions of Gastroenterology, Hepatology, and Nutrition, Rady Children\u2019s Hospital , San Diego, CA 92123,","place":["United States"]},{"name":"Department of Pediatrics, University of California San Diego , La Jolla, CA 92093,","place":["United 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