Martin W. Scobey

Clostridium difficile colitis: a retrospective study of incidence and severity before and after institution of an alcohol-based hand rub policy.

BACKGROUND Clostridium difficile-associated diarrhea is a leading cause of hospital-acquired diarrhea. We sought to determine whether the institution of a hospital-wide alcohol-based hand rub (ABHR) policy was associated with an increase in the incidence and/or severity of health care facility-onset, health care facility-associated C difficile diarrhea (CDAD). METHODS We used a retrospective chart review analysis to compare incidence rates of CDAD before and after implementation of the ABHR policy. We also compared rates of sepsis, colectomy, and death in patients with CDAD before and after implementation of the ABHR policy. RESULTS The incidence rate of CDAD was 3.98 per 10,000 patient-days after implementation of the ABHR policy, compared with 4.96 per 10,000 patient-days before implementation (P = .0036). The crude mortality rate in patients diagnosed with CDAD was 10.7% after implementation, compared with 13.3% before implementation (P = .275). The rate of sepsis in patients diagnosed with CDAD was 19.6% after implementation, compared with 5.2% before implementation (P < .0001). CONCLUSION Our data provide no evidence of an increased CDAD rate after implementation of an ABHR policy at our institution. The rate of sepsis in patients diagnosed with CDAD did rise, indicating increased severity of illness in patients with C difficile infection.

The Challenge of Clostridium difficile Infection.

Clostridium difficile infection is a major problem in the United States, resulting in significant morbidity, mortality, and financial costs to the health care system. This commentary provides an update regarding the epidemiology, diagnosis, current recommended management, and challenges surrounding C. difficile infection.

P-090 YI Assessing Provider Documentation of Inflammatory Bowel Disease Quality Measures

Background:Inflammatory bowel disease is characterized by chronic inflammation with episodic flares. The goal of IBD treatment is to achieve remission and control of symptoms while minimizing morbidity from the underlying disease and treatment side effects. Approximately 1.4 million Americans are affected by IBD and these visits account for 700,000 outpatient and 100,000 inpatient visits per year with an estimated healthcare cost of

Transmission Of Infection By Gastrointestinal Endoscopy

1.7 billion/year. Given the high costs and morbidity associated with IBD, the AGA established the 2011 “Adult Inflammatory Bowel Disease Physician Performance Measures Set” as a framework for high-quality IBD care. The 8 outpatient core measures include: (1) IBD type, anatomic location and activity all documented; (2) Corticosteroid-sparing therapy; (3) Corticosteroid related iatrogenic injury/bone loss assessment; (4) Influenza immunization; (5) Pneumococcal immunization; (6) Testing for latent TB before initiating anti-TNF therapy; (7)Assessment of hepatitis B status prior to initiating anti-TNF therapy; (8) Tobacco user screening and cessation intervention. These core measures have been validated by literature review and multidisciplinary expert panel, and physician ratings and payments are anticipated to be based on outcome measures and documented adherence to practice guidelines. Previous data have suggested that IBD patients may not be receiving optimal care even at tertiary centers. To date, there have been no studies investigating provider documentation, and therefore adherence to practice guidelines. Methods:A retrospective chart review of IBD patients seen in the outpatient setting in Carolinas HealthCare Gastroenterology Clinics from January 2011 to April 2014 was performed. Hundred patient charts were randomly selected based on ICD-9 diagnosis codes. Rates of gastroenterology provider (MD or PA) documentation of outpatient core measures were performed on clinic notes. Results:The data included 58 patients with CD and 42 patients with UC. Complete type, location and activity were documented in 77% of patients. Intermittent systemic steroids had been prescribed in 25% of patients. 22% were on anti-TNFs, and 20% were prescribed thiopurines. Of the patients who had received steroids, 32% had a documented bone density assessment or one was recommended. Thirteen percent of patients had influenza immunization status and 7% had pneumococcal immunization status documented. Provider documentation of TB status on anti-TNF therapy was noted in 72% of patients. Provider documentation of Hepatitis B status was present in 68%. There were 12 documented tobacco users, and 64% had documentation of smoking cessation counseling by the GI provider. Conclusions:Documentation of outpatient IBD quality measures could be improved. Disease type, location, and activity were documented to a reasonable degree. Smoking cessation counseling is being provided but could be better emphasized. Provider documentation of TB and Hepatitis B status of patients receiving anti-TNF could be improved but is likely underestimated in this review. The area of greatest improvement is preventive care including bone loss assessment for those patients receiving systemic steroids and immunizations for all IBD patients. Understanding these deficiencies in IBD care can help guide quality improvement initiatives and improve clinical outcomes and consistency in IBD care.