title: Impact of Specialized Inpatient IBD Care on Outcomes of IBD Hospitalizations: A Cohort Study.
abstract: The management of inflammatory bowel diseases (IBDs; Crohn's disease, ulcerative colitis) is increasingly complex. Specialized care has been associated with improved ambulatory IBD outcomes.
  
  
  
  To examine if the implementation of specialized inpatient IBD care modified short-term and long-term clinical outcomes in IBD-related hospitalizations.
  
  
  
  This retrospective cohort study included IBD patients hospitalized between July 2013 and April 2015 at a single tertiary referral center where a specialized inpatient IBD care model was implemented in July 2014. In-hospital medical and surgical outcomes as well as postdischarge outcomes at 30 and 90 days were analyzed along with measures of quality of in-hospital care. Effect of specialist IBD care was examined on multivariate analysis.
  
  
  
  A total of 408 IBD-related admissions were included. With implementation of specialized IBD inpatient care, we observed increased frequency of use of high-dose biologic therapy for induction (26% versus 9%, odds ratio 5.50, 95% confidence interval 1.30-23.17) and higher proportion of patients in remission at 90 days after discharge (multivariate odds ratio 1.60, 95% confidence interval 0.99-2.69). Although there was no difference in surgery by 90 days, among those who underwent surgery, early surgery defined as in-hospital or within 30 days of discharge, was more common in the study period (71%) compared with the control period (46%, multivariate odds ratio 2.73, 95% confidence interval 1.22-6.12). There was no difference in length of stay between the 2 years.
  
  
  
  Implementation of specialized inpatient IBD care beneficially impacted remission and facilitated early surgical treatment.
authors.affiliation: *Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; †University of Ottawa, Ottawa, Ontario, Canada; ‡Boston Medical Center, Boston, Massachusetts; §North Shore Community Health Center, Salem, Massachusetts; and ‖Harvard Medical School, Boston, Massachusetts.
authors.forename: Cindy C Y
authors.initials: CC
authors.lastname: Law
authors.forename: Saranya
authors.initials: S
authors.lastname: Sasidharan
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Rodrigues
authors.forename: Deanna D
authors.initials: DD
authors.lastname: Nguyen
authors.forename: Jenny
authors.initials: J
authors.lastname: Sauk
authors.forename: John
authors.initials: J
authors.lastname: Garber
authors.forename: Cosmas
authors.initials: C
authors.lastname: Giallourakis
authors.forename: Ramnik
authors.initials: R
authors.lastname: Xavier
authors.forename: Hamed
authors.initials: H
authors.lastname: Khalili
authors.forename: Vijay
authors.initials: V
authors.lastname: Yajnik
authors.forename: Ashwin N
authors.initials: AN
authors.lastname: Ananthakrishnan
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001691:Biological Therapy; D001900:Boston; D013505:Digestive System Surgical Procedures; D005260:Female; D006760:Hospitalization; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000628:therapy*; D007297:Inpatients; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012042:Registries; D012074:Remission Induction; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones