Geoffrey C Nguyen1, Sanjay K Murthy, Brian Bressler, Mindy C W Lam, Ali Alali, Asmae Toumi, Jason Reinglas, Adam Rampersad, Adam V Weizman, Waqqas Afif. 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.
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. difficileinfection, 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.
Authors: Adam S Faye; Kenneth W Hung; Kimberly Cheng; John W Blackett; Anna Sophia Mckenney; Adam R Pont; Jianhua Li; Garrett Lawlor; Benjamin Lebwohl; Daniel E Freedberg Journal: Inflamm Bowel Dis Date: 2020-08-20 Impact factor: 5.325
Authors: Lea I Kredel; Oliver Schneidereit; Jörg C Hoffmann; Britta Siegmund; Jan C Preiß Journal: Int J Colorectal Dis Date: 2018-12-07 Impact factor: 2.571
Authors: M Ellen Kuenzig; Eric I Benchimol; Lawrence Lee; Laura E Targownik; Harminder Singh; Gilaad G Kaplan; Charles N Bernstein; Alain Bitton; Geoffrey C Nguyen; Kate Lee; Jane Cooke-Lauder; Sanjay K Murthy Journal: J Can Assoc Gastroenterol Date: 2018-11-02
Authors: Adam V Weizman; Brian Bressler; Cynthia H Seow; Waqqas Afif; Nooran M Afzal; Laura Targownik; Derek M Nguyen; Jennifer L Jones; Vivian Huang; Sanjay K Murthy; Geoffrey C Nguyen Journal: J Can Assoc Gastroenterol Date: 2020-06-09