Impact of gastroenterologist care on health outcomes of hospitalised ulcerative colitis patients

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.