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Impact of gastroenterologist care on health outcomes of hospitalised ulcerative colitis patients
  1. Sanjay K Murthy1,
  2. A Hillary Steinhart1,2,
  3. Jill Tinmouth2,3,4,
  4. Peter C Austin2,4,
  5. Geoffrey C Nguyen1,2,4
  1. 1Mount Sinai Hospital IBD Centre, Department of Medicine, University of Toronto, Toronto, Canada
  2. 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
  3. 3Division of Gastroenterology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
  4. 4Institute for Clinical Evaluative Sciences, Toronto, Canada
  1. Correspondence to Dr Sanjay Murthy, Mount Sinai Hospital, 445-600 University Avenue, Toronto, ON M5G 1X5, Canada; sanjay.murthy{at}utoronto.ca

Abstract

Objectives To evaluate the impact of in-hospital gastroenterologist care, relative to other provider care, on health outcomes of hospitalised Ulcerative colitis (UC) patients.

Design A population-based cohort study of 4278 UC patients hospitalised between 2002 and 2008 was conducted in Ontario, Canada. The primary outcome was in-hospital mortality risk.

Results UC patients admitted under non-gastroenterologists had a higher in-hospital mortality rate (1.1 vs 0.2%, p<0.0001) but a similar in-hospital colectomy rate (5.4 vs 4.9%, p=0.69) as compared to UC patients admitted under gastroenterologists. Following covariate adjustment, non-gastroenterologist care was associated with a greater in-hospital mortality risk relative to gastroenterologist care (adjusted OR (aOR) 3.28, 95% CI 1.03 to 10.5). This increased mortality risk was observed in patients admitted to other internists (OR 5.49, 95% CI 1.75 to 17.2) and general practitioners (OR 6.02, 95% CI 1.84 to 19.7), with a trend towards greater mortality risk among patients admitted to general surgeons (OR 3.49, 95% CI 0.90 to 13.6). Among patients who were discharged from hospital colectomy-free, those who were admitted under non-gastroenterologists had a greater one-year risk of death than patients who were admitted under gastroenterologists (adjusted HR 2.07, 95% CI 1.26 to 3.40). The type of hospital provider did not impact in-hospital or one-year colectomy risks or the risk of hospital re-admission in this cohort.

Conclusions Primary in-hospital gastroenterologist care was associated with decreased in-hospital and one-year mortality risks among hospitalised UC patients. Optimised care strategies by experienced specialists may confer important health advantages in this patient population.

  • Ulcerative colitis
  • inflammatory bowel disease
  • specialist care
  • gastroenterologist
  • health outcomes
  • mortality
  • crohn's disease
  • colorectal neoplasia
  • endoscopy
  • infliximab
  • IBD
  • clinical trials
  • IBD clinical
  • health economics
  • health outcomes
  • health disparities
  • health service research

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Footnotes

  • Link to description of Data Integration, Measurement and Reporting Hospital Discharge. Abstract Database from Alberta Health Region (Alberta version of CIHI-DAD): http://www.health.alberta.ca/documents/Research-Health-Databases.pdf

  • Competing interests None.

  • Patient consent All data was provided de-itentified to the authors of the study. Additionally, all data is presented only inaggregate form in this manuscript. No patient identifying information is provided.

  • Ethics approval The ethics approval was provided by Institute for Clinical Evaluative Sciences Privacy Office.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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