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

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

Author information

1
*Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada; †Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ‡Department of Medicine, The Ottawa Hospital IBD Centre, University of Ottawa, Ottawa, Ontario, Canada; §Division of Gastroenterology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and ‖Division of Gastroenterology, McGill University, Montreal, Québec, Canada.

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.

PMID:
28426451
DOI:
10.1097/MIB.0000000000001068
[Indexed for MEDLINE]

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