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

Abstract

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.

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Correspondence to Simon J. Hong.

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Conflict of interest

Simon J. Hong, Janice Jang, Dana R. Berg, Tarik Kirat and Feza Remzi have no disclosures. Shannon Chang has served as a consultant for Pfizer, Shire, and Oshi Health. Lisa B. Malter has received educational or IBD fellowship education grants from AbbVie, Gilead, Janssen Pharmaceuticals, Merck & Co., Inc, Pfizer, Prometheus, Laboratories, Takeda, and UCB. Jordan A. Axelrad has received research support from BioFire Diagnostics and has served as a consultant for BioFire Diagnostics and Janssen Pharmaceuticals. David P. Hudesman has received research support from Pfizer and has served as a consultant for Abbvie, BMS, Janssen, Takeda, Pfizer, and Samsung.

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This study was approved by the Institutional Review Board at NYU Langone Health.

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Hong, S.J., Jang, J., Berg, D. et al. Implementation of an Inpatient IBD Service Is Associated with Improvement in Quality of Care and Long-Term Outcomes. Dig Dis Sci (2021). https://doi.org/10.1007/s10620-020-06749-7

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Keywords

  • Inflammatory bowel disease
  • Inpatient
  • Quality of care
  • Outcomes