Impact of Specialized Inpatient IBD Care on Outcomes of IBD Hospitalizations

Law, Cindy; Sasidharan, Saranya; Rodrigues, Rodrigo; Nguyen, Deanna D.; Sauk, Jenny; Garber, John; Giallourakis, Cosmas; Xavier, Ramnik J.; Khalili, Hamed; Yajnik, Vijay; Ananthakrishnan, Ashwin N.

doi:10.1097/mib.0000000000000870

Cited by 43 publications

(20 citation statements)

References 32 publications

(40 reference statements)

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“…8, 9, 15 Even within a single referral hospital, implementation of specialized IBD care pathway and dedicated care by a gastroenterologist specializing in IBD was associated with higher rates of remission at 3 months and facilitated early surgical intervention. 7 Equivalent results were observed in studies assessing the influence of specialized care in other diseases. 16–20 Thus overall, evidence suggests that the best outcomes in IBD may be obtained in specialized setting, particularly for patients at risk for more severe disease or requiring complex, multidisciplinary care.…”

Section: Discussionmentioning

confidence: 97%

“…6, 7 Care at a high IBD volume hospital is associated with lower post-operative mortality among patients undergoing surgery. 8, 9 Among hospitalized patients with UC, gastroenterologist care was associated with lower mortality for up to 1 year after the initial hospitalization compared to admissions under internists and general practitioners.…”

Section: Introductionmentioning

confidence: 99%

“…6 Even in a tertiary referral center, care by gastroenterologists specializing in IBD resulted in superior post-hospitalization outcomes and earlier access to IBD-related surgical interventions. 7 The impact of barrier to effective care may extend even prior to the diagnosis of IBD where a delay may reduce response to medical therapy, increase risk of fibrostenosis and need for surgery. 10, 11 …”

Section: Introductionmentioning

confidence: 99%

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Distance to Specialist Care and Disease Outcomes in Inflammatory Bowel Disease

Conway

Tan

Andrews

et al. 2017

Inflammatory Bowel Diseases

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Introduction Optimal treatment of inflammatory bowel disease requires specialized health care. Patients frequently travel long distances to obtain care for inflammatory bowel disease, which may hinder regular care and affect outcomes adversely. Methods This study included patients with established CD or UC receiving care at a single referral center between January 2005 and August 2016. Distance to our healthcare center from the zip code of residence was determined for each patient and classified into quartiles. Our primary outcome was need for IBD-related surgery with secondary outcomes being need for biologic and immunomodulator therapy. Logistic regression models adjusting for relevant covariates examined the independent association between travel distance and patient outcomes. Results Our study included 2,136 patients with IBD (1,197 CD, 939 UC) among just over half were women (52%) and the mean age was 41 years. The mean distance from our hospital was 2.5 miles, 8.8 miles, 22.0 miles, and 50.8 miles for the first (most proximal) through fourth (most distant) respectively. We observed a statistically significant and meaningful higher risk among patients in the most distant quartile in the need for immunomodulator use (OR 1.69, 95% CI 1.29–2.22), biological therapy (OR 2.19, 95% CI 1.69–2.85) and surgery (OR 2.44, 95% CI 1.80 – 3.32). Differences remained significant on multivariable analysis and by type of IBD. Conclusion Greater distance to referral healthcare center was associated with increased risk for needing IBD-related surgery in patients with Crohn’s disease or ulcerative colitis.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Distance to Specialist Care and Disease Outcomes in Inflammatory Bowel Disease

Conway

Tan

Andrews

et al. 2017

Inflammatory Bowel Diseases

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“…Finally, the assertion of Solberg et al that more patients with severe disease are treated in specialized centers, where they are more likely to be included in retrospective studies, cannot be refuted [ 39 ]. However, because of the increasingly complex management of IBD, particularly for severe cases, admission to high-IBD-volume hospitals has been shown to be associated with better outcomes in both CD and UC [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Crohn’s disease: prevalence, MR features, and clinical significance of enteric and colonic sinus tracts

et al. 2020

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Objectives Enteric and colonic sinus tracts are inflammatory complications that precede intestinal fistulas in patients with Crohn’s disease (CD). The aim of this study was to retrospectively determine the prevalence, morphologic features, and outcome of sinus tracts using MR imaging. Methods A consecutive cohort of 642 patients with known CD, referred for MR enterography or MR enteroclysis (study period 01/2014–09/2019), was evaluated retrospectively for the presence of sinus tracts, their locations, presence and length of coexisting strictures, bowel wall thickness, CDMI score, upstream dilation, and bowel distension. Clinical outcome was assessed using medical records. For metric data, means and standard deviation, as well as one-way ANOVA and Pearson’s correlation coefficient, were calculated. Results In 36/642 patients with CD undergoing MRE, 49 sinus tracts (forty in small intestine, nine in left-sided colon) were detected with a prevalence of 6.9% in patients with MR-visible signs of CD (n = 519, overall prevalence of 5.6%). Mean segmental bowel wall thickness was 8.9 mm, and mean CDMI score was 9.3. All sinus tracts were located within a stenotic segment, showing mesenteric orientation within the small bowel and upstream dilation in 13 patients. Of 36 patients, 19 underwent immediate surgery and seven developed clinical progression within the segment containing the sinus tract. Conclusions Sinus tracts occur in 6.9% of patients with visible signs of CD. They are located within stenotic, severely thickened bowel segments with high MR inflammation scores. Their detection is clinically important, because they indicate a more aggressive phenotype and, if left untreated, may show severe progression. Key Points • Sinus tracts occur in 6.9% of patients with MR-visible signs of Crohn’s disease. • Sinus tracts are a radiological indicator of early penetrating Crohn’s disease, with a high risk of progression, and require dedicated treatment. • Sinus tracts can be recognized by characteristic findings and typically occur in stenotic, severely thickened bowel segments with high MR inflammation scores.

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“…Law et al[ 35 ] performed a cohort study focusing on the impact of having exclusively subspecialized IBD trained physicians manage IBD patients admitted to hospital on short and long term clinical outcomes. They compared a cohort whereby inpatients were managed under general gastroenterology care to ones managed under specialized IBD care.…”

Section: Evidence Surrounding Qi Applicationmentioning

confidence: 99%

Quality of care in inflammatory bowel diseases: What is the best way to better outcomes?

Strohl

Gönczi

Kurt

et al. 2018

WJG

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Inflammatory bowel disease (IBD) is a lifelong, progressive disease that has disabling impacts on patient’s lives. Given the complex nature of the diagnosis of IBD and its management there is consequently a large economic burden seen across all health care systems. Quality indicators (QI) have been created to assess the different façades of disease management including structure, process and outcome components. Their development serves to provide a means to target and measure quality of care (QoC). Multiple different QI sets have been published in IBD, but all serve the same purpose of trying to achieve a standard of care that can be attained on a national and international level, since there is still a major variation in clinical practice. There have been many recent innovative developments that aim to improve QoC in IBD including telemedicine, home biomarker assessment and rapid access clinics. These are some of the novel advancements that have been shown to have great potential at improving QoC, while offloading some of the burden that IBD can have vis-a-vis emergency room visits and hospital admissions. The aim of the current review is to summarize and discuss available QI sets and recent developments in IBD care including telemedicine, and to give insight into how the utilization of these tools could benefit the QoC of IBD patients. Additionally, a treating-to-target structure as well as evidence surrounding aggressive management directed at tighter disease control will be presented.

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Impact of Specialized Inpatient IBD Care on Outcomes of IBD Hospitalizations

Cited by 43 publications

References 32 publications

Distance to Specialist Care and Disease Outcomes in Inflammatory Bowel Disease

Distance to Specialist Care and Disease Outcomes in Inflammatory Bowel Disease

Crohn’s disease: prevalence, MR features, and clinical significance of enteric and colonic sinus tracts

Quality of care in inflammatory bowel diseases: What is the best way to better outcomes?

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