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

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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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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center at, New York University Langone Health, 305 East 33rd Street, New York, NY, 10016, USA

    Simon J. Hong, Janice Jang, Dana Berg, Tarik Kirat, Feza Remzi, Shannon Chang, Lisa B. Malter, Jordan E. Axelrad & David P. Hudesman

Authors
  1. Simon J. Hong
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  2. Janice Jang
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  3. Dana Berg
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  4. Tarik Kirat
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  5. Feza Remzi
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  6. Shannon Chang
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  7. Lisa B. Malter
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  8. Jordan E. Axelrad
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  9. David P. Hudesman
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Corresponding author

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.

Ethical approval

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 66, 3753–3759 (2021). https://doi.org/10.1007/s10620-020-06749-7

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  • DOI: https://doi.org/10.1007/s10620-020-06749-7

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