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Opportunities for Improvement in the Care of Patients Hospitalized for Inflammatory Bowel Disease-Related Colitis

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Abstract

Background

Algorithms for the diagnosis, management, and follow-up have been proposed for patients hospitalized for inflammatory bowel disease (IBD) colitis flare. The degree to which providers adhere to these algorithms is unknown. This study evaluated the quality of care in IBD patients hospitalized for disease-associated exacerbations and factors correlated with higher degrees of care.

Methods

Retrospective chart review of 34 patients during 60 admissions to the medicine service for IBD colitis exacerbation between 2005 and 2012 at the Veterans Affairs San Diego Medical Center. Examined factors included laboratory testing, timing of consultation and intravenous steroids, abdominal imaging, endoscopic examination, venous thromboembolism (VTE) prophylaxis, narcotic use, Clostridium difficile and cytomegalovirus testing, symptomatology at discharge, timing of follow-up, and rates of readmission and mortality.

Results

Quality of care varied among the factors studied, ranging from 30.5 % for pharmacologic VTE prophylaxis to 84.7 % for gastroenterology consultation within 24 h. Of 60 admissions, 22 % were not tested for C. difficile. Fifteen percent of patients were discharged before meeting commonly used discharge criteria. Eighty percent were seen in clinic at any time post-discharge; 6.7 % were readmitted; 10 % were lost to follow-up; 1.7 % opted for outside follow-up; and 1.7 % expired.

Conclusions

The quality of care for patients admitted with IBD colitis flares is variable. These data outline opportunities for improvement, particularly in regard to pain management, VTE prophylaxis, and follow-up. Further studies are needed to test intervention strategies for practice improvement.

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Abbreviations

IBD:

Inflammatory bowel disease

VHA:

Veterans Health Administration

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Acknowledgments

Funding for this study was provided by the Research Service of the Department of Veterans Affairs, Veterans Affairs HSR&D, and Office of Public Health/Clinical Public Health (10P3B). Samuel B. Ho, MD, has received research and grant support from Genetech, Inc., Vital Therapies, Inc., Aspire Bariatrics, Inc., Prime Education, Inc., Abbvie, Inc., and Gilead, Inc.

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Authors and Affiliations

  1. VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA

    Noel S. Lee, Erik J. Groessl, Jesus Rivera-Nieves & Samuel B. Ho

  2. University of California, San Diego, San Diego, CA, USA

    Noel S. Lee, Erik J. Groessl, Jesus Rivera-Nieves & Samuel B. Ho

  3. Kaiser Permanente San Diego, San Diego, CA, USA

    Suresh Pola

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  1. Noel S. Lee
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Correspondence to Samuel B. Ho.

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Lee, N.S., Pola, S., Groessl, E.J. et al. Opportunities for Improvement in the Care of Patients Hospitalized for Inflammatory Bowel Disease-Related Colitis. Dig Dis Sci 61, 1003–1012 (2016). https://doi.org/10.1007/s10620-016-4046-0

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