Implementation of an Inpatient IBD Service Is Associated with Improvement in Quality of Care and Long-Term Outcomes

• Published in: Digestive diseases and sciences Vol. 66; no. 11; pp. 3753 - 3759
• Main Authors: Hong, Simon J., Jang, Janice, Berg, Dana, Kirat, Tarik, Remzi, Feza, Chang, Shannon, Malter, Lisa B., Axelrad, Jordan E., Hudesman, David P.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-11-2021; Springer; Springer Nature B.V
• Subjects: Biochemistry; Care and treatment; Disease prevention; Evidence-based medicine; Gastroenterology; Hepatology; Hospital patients; Inflammatory bowel disease; Inpatient care; Medical care; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Oncology; Original Article; Patient outcomes; Patients; Quality management; Quality of care; Remission (Medicine); Transplant Surgery; Ulcerative colitis; Inflammatory bowel disease; Inpatient; Quality of care; Outcomes
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-020-06749-7

Background
There is wide variation in the quality of care of hospitalized patients with inflammatory bowel disease (IBD). Prior studies have demonstrated that a specialized inpatient IBD service improves short-term outcomes. In this study, we assessed the impact of a dedicated IBD service on the quality of care and long-term outcomes.
Methods
This retrospective cohort study included adult patients admitted for a complication of IBD between March 2017 and February 2019 to a tertiary referral center. In March 2018, a dedicated inpatient IBD service co-managed by IBD gastroenterologists and colorectal surgeons was implemented. Quality of care outcomes included C.
difficile
stool testing, confirmed VTE prophylaxis administration and opiate avoidance. Long-term outcomes were clinical remission, IBD-related surgery, ED visits, and hospital readmissions at 90 days and 12 months.
Results
In total, 143 patients were included; 66 pre- and 77 post-implementation of the IBD service. Fifty-two percent had ulcerative colitis and 48% had Crohn’s disease. After implementation, there was improvement in C.
difficile
testing (90% vs. 76%,
P
 = 0.04), early VTE prophylaxis (92% vs. 77%,
P
 = 0.01) and decreases in narcotic use (14% vs. 30%,
P
 = 0.02), IBD-related ED visits at 90 days (7% vs 18%,
P
 = 0.03) and 12 months (16% vs 30%,
P
 = 0.04), and IBD readmissions at 90 days (16% vs. 30%,
P
 = 0.04). There were no differences in rates of clinical remission or surgery.
Conclusions
The creation of a dedicated inpatient IBD service improved quality of IBD care and reduced post-discharge ED visits and readmissions and broader implementation of this strategy may help optimize care of hospitalized IBD patients.