住院炎症性肠病患者的医疗质量与结局：一项多中心回顾性研究
Quality of Care and Outcomes Among Hospitalized Inflammatory Bowel Disease Patients: A Multicenter Retrospective Study.
作者信息
Nguyen Geoffrey C, Murthy Sanjay K, Bressler Brian, Lam Mindy C W, Alali Ali, Toumi Asmae, Reinglas Jason, Rampersad Adam, Weizman Adam V, Afif Waqqas
机构信息
*Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada; †Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ‡Department of Medicine, The Ottawa Hospital IBD Centre, University of Ottawa, Ottawa, Ontario, Canada; §Division of Gastroenterology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and ‖Division of Gastroenterology, McGill University, Montreal, Québec, Canada.
出版信息
Inflamm Bowel Dis. 2017 May;23(5):695-701. doi: 10.1097/MIB.0000000000001068.
BACKGROUND
Half of patients with inflammatory bowel disease (IBD) require hospitalization. We sought to characterize inpatient quality indicators of care and outcomes during IBD-related hospitalizations at 4 major IBD referral centers in Canada.
METHODS
We conducted a multicenter retrospective cohort study of patients with IBD admitted from 2011 to 2013 to tertiary centers in Toronto, Montreal, Ottawa, and Vancouver. We assessed the following inpatient indicators of care: pharmacological venous thromboembolism (VTE) prophylaxis, Clostridium difficile testing, and medical rescue therapy for steroid-refractory ulcerative colitis (UC). We also evaluated rates of VTE, C. difficile infection, and IBD-related surgery.
RESULTS
There were 837 patients hospitalized for IBD (Crohn's disease, 59%; UC, 41%). The proportion of patients with IBD who received VTE prophylaxis and C. difficile testing were 77% and 82%, respectively, although these indicators varied significantly by center and admitting specialty. Patients admitted under surgeons were more likely than those admitted under gastroenterologists to receive VTE prophylaxis (84% versus 74%, P = 0.016) but less likely to be tested for C. difficile (41% versus 88%, P < 0.0001). The rate of VTE was the same for those who did and did not receive VTE prophylaxis (2.2 per 1000 hospital-days). Among the 14 VTE events, 79% had received prophylaxis, but only 36% within 24 hours of admission. Among steroid-refractory UC patients, 70% received rescue therapy within 7 days of steroid initiation. The proportion of patients with UC and CD who required respective bowel surgery was 18% and 20%, respectively.
CONCLUSIONS
There are opportunities to optimize quality of care among hospitalized patients with IBD.
背景
炎症性肠病（IBD）患者中有一半需要住院治疗。我们试图描述加拿大4个主要IBD转诊中心在IBD相关住院期间的住院护理质量指标和结局。
方法
我们对2011年至2013年入住多伦多、蒙特利尔、渥太华和温哥华三级中心的IBD患者进行了一项多中心回顾性队列研究。我们评估了以下住院护理指标：药物性静脉血栓栓塞（VTE）预防、艰难梭菌检测以及类固醇难治性溃疡性结肠炎（UC）的医疗抢救治疗。我们还评估了VTE、艰难梭菌感染和IBD相关手术的发生率。
结果
有837例IBD患者住院（克罗恩病占59%；UC占41%）。接受VTE预防和艰难梭菌检测的IBD患者比例分别为77%和82%，尽管这些指标因中心和收治专科而有显著差异。外科医生收治的患者比胃肠病学家收治的患者更有可能接受VTE预防（84%对74%，P = 0.016），但接受艰难梭菌检测的可能性较小（41%对88%，P < 0.0001）。接受和未接受VTE预防的患者VTE发生率相同（每1000住院日2.2例）。在14例VTE事件中，79%的患者接受了预防，但只有36%在入院后24小时内接受。在类固醇难治性UC患者中，70%在开始使用类固醇后7天内接受了抢救治疗。UC和CD患者需要进行相应肠道手术的比例分别为18%和20%。
结论
在住院的IBD患者中，有机会优化护理质量。
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