P309. Transition experience from inpatient to ambulatory IBD care: Results of a pilot study
A. Romanova1, D. Armstrong1, U. Chauhan1, S. Halder1, S. Kelly2, P. Moayyedi1, F. Tse1, J. Marshall1, 1McMaster University, Gastroenterology, Hamilton, Canada, 2McMaster University, General Surgery, Hamilton, Canada
Management of inflammatory bowel disease (IBD) is inherently multidisciplinary and often fragmented. Despite advances in therapy, many patients will require hospital admission and 50% will require at least one surgery to manage their disease. The transition from inpatient to outpatient care is a vulnerable time for patients. Healthcare transition periods are associated with poorer health outcomes, and a structured transition program may improve compliance and disease control.
We conducted a prospective survey of 67 adults with IBD transitioning from inpatient to ambulatory care in order to better understand their experiences and how their transition can be improved. We used validated instruments to assess satisfaction with transition and medical care, self-perceived physical and mental health status, as well as health-related quality of life at transition.
26 subjects (38.8%) provided adequate data for analysis, of whom 18 (69.2%) had Crohn's disease and 8 (30.8%) had ulcerative colitis. The mean age at transition was 43±17 years. The median disease duration was 10 years (range 0.25–30). 9 hospitalizations (34.6%) were medical and 17 (65.4%) were surgical, with median lengths of stay 5.5 (range 1–15) and 8.5 (range 5–62) days, respectively. Responses to the Inflammatory Bowel Disease Questionnaire (IBDQ) showed that quality of life at transition was good for 10 subjects (38.5%), regular for 12 (46.2%), and bad for 4 (15.4%). Compared to normative Canadian data, SF36 scores from our subjects demonstrated decreased physical and social functioning, general health, emotional health and well-being with increased pain and fatigue. Using the Care Transitions Measure 15 (CTM-15), 16 subjects (61.5%) reported the quality of their care transition to be good and 5 (19.2%) reported it to be excellent. Mean domain scores from the Patient Satisfaction Questionnaire (PSQ) were 2.88 (SD 1.77) for general satisfaction, 3.01 (SD 1.60) for technical quality, 3.42 (SD 1.72) for interpersonal manner, 2.44 (SD 1.87) for communication, 2.73 (SD 1.55) for financial aspects, 2.50 (SD 1.75) for time with the doctor, and 2.81 (SD 1.72) for accessibility.
There is a clear need for transition strategies that help adults with IBD manage their disease after discharge from the hospital and during their transition back to ambulatory care. Strategies to bridge this gap have not been formally evaluated. These data assess the outcome of inpatient to ambulatory care transition under our current standard of care. The McMaster University/Hamilton Health Sciences IBD Clinic is exploring a formal transition program led by a dedicated IBD nurse practitioner. Our outcomes will be reassessed following introduction of this pilot program.