Quality of Care and Outcomes Among Hospitalized Inflammatory Bowel Disease Patients: A Multicenter Retrospective Study

Inflamm Bowel Dis. 2017 May;23(5):695-701. doi: 10.1097/MIB.0000000000001068.

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.

Publication types

  • Evaluation Study
  • Multicenter Study

MeSH terms

  • Adult
  • Anticoagulants / therapeutic use
  • Canada / epidemiology
  • Clostridium difficile
  • Colitis, Ulcerative / complications
  • Colitis, Ulcerative / drug therapy
  • Colitis, Ulcerative / microbiology
  • Enterocolitis, Pseudomembranous / diagnosis
  • Enterocolitis, Pseudomembranous / microbiology
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Inflammatory Bowel Diseases / complications
  • Inflammatory Bowel Diseases / microbiology
  • Inflammatory Bowel Diseases / therapy*
  • Inpatients / statistics & numerical data*
  • Male
  • Mass Screening / methods
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Patient Outcome Assessment*
  • Quality of Health Care / statistics & numerical data*
  • Retrospective Studies
  • Steroids / therapeutic use
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control

Substances

  • Anticoagulants
  • Steroids