Quality of Care and Outcomes Among Hospitalized Inflammatory Bowel Disease Patients: A Multicenter Retrospective Study. Issue 5 (21st March 2017)

• Record Type: Journal Article
• Authors: Nguyen, Geoffrey C.; Murthy, Sanjay K.; Bressler, Brian; Lam, Mindy C. W.; Alali, Ali; Toumi, Asmae; Reinglas, Jason; Rampersad, Adam; Weizman, Adam V.; Afif, Waqqas
• Is Part Of: Inflammatory bowel diseases. Volume 23:Issue 5(2017)
• Page Start: 695
• Page End: 701
• Publication Date: 2017-03-21
• Subjects: venous thromboembolism -- Crohn's disease -- ulcerative colitis -- Clostridium difficile -- surgery; Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1097/MIB.0000000000001068
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract : Background: Half of patients with inflammatory bowel disease (IBD) require hospitalization. We sought to characterize inpatient quality indicators of care and outcomes during IBD-related hospitalizations at 4 major IBD referral centers in Canada. Methods: We conducted a multicenter retrospective cohort study of patients with IBD admitted from 2011 to 2013 to tertiary centers in Toronto, Montreal, Ottawa, and Vancouver. We assessed the following inpatient indicators of care: pharmacological venous thromboembolism (VTE) prophylaxis, Clostridium difficile testing, and medical rescue therapy for steroid-refractory ulcerative colitis (UC). We also evaluated rates of VTE, C. difficile infection, and IBD-related surgery. Results: There were 837 patients hospitalized for IBD (Crohn's disease, 59%; UC, 41%). The proportion of patients with IBD who received VTE prophylaxis and C. difficile testing were 77% and 82%, respectively, although these indicators varied significantly by center and admitting specialty. Patients admitted under surgeons were more likely than those admitted under gastroenterologists to receive VTE prophylaxis (84% versus 74%, P = 0.016) but less likely to be tested for C. difficile (41% versus 88%, P < 0.0001). The rate of VTE was the same for those who did and did not receive VTE prophylaxis (2.2 per 1000 hospital-days). Among the 14 VTE events, 79% had received prophylaxis, but only 36% within 24 hours of admission. Among steroid-refractory UC patients, 70% received rescue therapy within 7 days of steroid initiation. The proportion of patients with UC and CD who required respective bowel surgery was 18% and 20%, respectively. Conclusions: There are opportunities to optimize quality of care among hospitalized patients with IBD.