Evaluation of the Quality-of-Care Parameters in Patients With Inflammatory Bowel Disease in Brazilian Hospitals
AIBD 2023
Background:
There are few data on the quality-of-care for inflammatory bowel disease (IBD) in public, private or mixed hospitals. Aim: To evaluated clinic and quality parameters and their association with need for ICU and death in Brazilian hospitals.
Methods:
Multicentre study carried out in 26 hospitals including 488 admissions of patients with IBD were analyzed between June 2021 and October 2022.
Results:
The median stay length was 6 days (0–121). The median age was 38 years (16–87), and 265 (54.6%) were female; 339 patients (69.5%) had Crohn’s disease (CD) and 149 (30.5%) ulcerative colitis (UC). In the CD group, there was structural damage in 248 cases (73.2%). UC in pancolitis form was seen in 97 (66%). The Charlson Comorbidity Index (CCI) was scored at least at one point in 182 records (37.3%). 307 admissions (62.9%) were urgent, and 208 cases (42,6%) remained in the emergency room (ER) for 2 days (1-22). Disease activity and structural damage accounted for 58.6% of admissions. There were 153 surgeries (37.5%), and 35 (18.1%) postoperative complications. The most prescribed drugs were biologicals (52.8%) before admission and corticosteroids during hospitalization period (37.3%). Red days were verified in 45.3%. Admission to the ICU was required in 55 cases (11.3%). One hundred and nine (22.3%) bacterial infections were registered. There were 16 deaths (3.3%), and the main cause was sepsis (37.5%). The CCI of 1 best predicted the need for ICU (AUROC 0.588; S 52.7%, E 64.7%) and death (AUROC 0.782; S 81.3%, E 64.2%). The need for intestinal resection (p=0.003; OD= 3.515; 95% IC, 1.516-8.156) and infectious complications (p=0.006; OD= 5.605; 95% IC, 2,508- 12,527) were associated to admission on ICU. Admissions associated with IBD complications (p=0.013; OD=4,442; 95% IC 1.314-14.358) and infectious complications (p=0.000; OD=10.823; 95% IC 2.998-39.078) were associated to death. The need to stay in ER and red days were lower in private and mixed hospitals (p= 0.000). Infection and death rates were similar (p= 0.323).
Conclusions:
The accuracy of the CCI in predicting ICU and death was obtained. Infectious complications were associated with both outcomes. System deficiency was more evident in public hospitals in the proportion of individuals who remained in the emergency room. From the red days, greater agility in solving problems was found in private and mixed hospitals.
