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Inflammatory bowel disease in the UK: is quality of care improving?
  1. Laith Alrubaiy1,
  2. Ian Arnott2,
  3. Aimee Protheroe3,
  4. Michael Roughton3,
  5. Richard Driscoll4,
  6. John G Williams1
  1. 1College of Medicine, Swansea University, Swansea, UK
  2. 2Western General Hospital, Edinburgh, UK
  3. 3Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK
  4. 4Crohn's and Colitis UK, St Alban's, UK
  1. Correspondence to Dr Laith Alrubaiy, College of Medicine, Swansea University, Room 220, Grove Building, Swansea SA2 8PP, UK; l.alrubaiy{at}swansea.ac.uk

Abstract

Objective A national audit conducted in 2005/6 showed unacceptable quality of care for inpatients with inflammatory bowel disease (IBD) in the UK. This was re-audited in 2007/8 and 2010/11. The aim of this study is to examine the quality of care provided for inpatients with IBD in the UK.

Design A programme of engagement and re-audit in 128 hospitals in the UK providing care for adult patients with IBD admitted to hospital between 1 June 2005 and 31 May 2006, 1 September 2007 and 31 August 2008 and 1 September 2010 and 31August 2011.

Interventions Wide dissemination of the results, selected site visits, development of national service standards, and the development of an online document repository.

Main outcome measures Mortality, medical and surgical treatment, specialist nursing and dietetic care were audited.

Results Data from 1953, 2016 and 1948 patients with ulcerative colitis (UC) and 2074, 2109 and 1900 patients with Crohn's disease (CD) were audited in 2005/6, 2007/8 and 2010/11, respectively. The mortality rate fell from 1.7% to 0.8% (p=0.034) in UC and from 1.3% to 0.8% (p=0.226) in CD. The proportion of inpatients reviewed by an IBD specialist nurse has risen from 23.7% to 44.9% in UC and from 18.1% to 39.9% (p<0.001) in CD. Anti-tumour necrosis factor therapy has increased in UC and CD (p<0.001) while ciclosporin prescription has slightly fallen in UC. Laparoscopic surgeries have significantly increased in UC and CD (p<0.001).

Conclusions The results show clear evidence of improvement in most aspects of the quality of care for IBD inpatients.

  • IBD
  • Crohn's Disease
  • Ulcerative Colitis
  • Inflammatory Bowel Disease
  • Health Service Research

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