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Yan X, Qiao Y, Tong J, Mao R, Liang J, Lv C, Chen Y, Wang Y, Shen J. Assessment of patient-centered outcomes (PROs) in inflammatory bowel disease (IBD): a multicenter survey preceding a cross-disciplinary (functional) consensus. Health Qual Life Outcomes 2020; 18:241. [PMID: 32690091 PMCID: PMC7372780 DOI: 10.1186/s12955-020-01489-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 07/10/2020] [Indexed: 02/08/2023] Open
Abstract
Background With a shift in the healthcare paradigm towards a more patient-centered approach, data on inflammatory bowel disease (IBD) needs to be further explored. This study aimed to determine patient perspectives on the effect of IBD and features of patients with lower satisfaction level and compare patient and physician perception of IBD-related Quality of Care (QoC). Methods A previously developed pre-standardised set of questions regarding patient-centered outcome (PRO) measures for IBD, comprising 36 items, was administered in five centers, and a concomitant questionnaire for specialised physicians was adapted and administered. Results Overall, 1005 patients with IBD met the inclusion criteria. Sixty-five questionnaires were administered to specialised physicians. Both patients and physicians perceived the IBD-related QoC as being satisfactory. Furthermore, this study revealed areas of shortcomings where it comes to patient perceptions. Female sex and the presence of negatively impacting disease characteristics (presence of significant pain or discomfort, lack of energy, feeling fatigued most of the time, experiencing anxiety or depression in the last 2 weeks) were associated with lower satisfaction levels. Conclusions Our findings can be used in establishing strategies aimed at improving patient QoC and defining strategic priorities. These data can aid in improving the communication of the pressing needs of IBD patients, to both the public payers and health authorities.
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Affiliation(s)
- Xiaohan Yan
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center; Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, 160# Pu Jian Ave, Shanghai, 200127, China.,Endoscopy Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Yuqi Qiao
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center; Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, 160# Pu Jian Ave, Shanghai, 200127, China
| | - Jinglu Tong
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center; Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, 160# Pu Jian Ave, Shanghai, 200127, China
| | - Ren Mao
- Department of Gastroenterology, the First Affiliated Hospital, Sun Yat-sen University, No.58, Zhong Shan Er Lu, Guangzhou, 510080, China
| | - Jie Liang
- Department of Gastroenterology, Xijing Hospital, Air Force Medical University, Chang Le Xi Lu, Xi'an, 710032, China
| | - Cuicui Lv
- Department of Gastroenterology, the Third Hospital, Liao Cheng, China
| | - Yueying Chen
- Department of Gastroenterology, Zhong Shan Hospital, the Xiamen University, Xiamen, China
| | - Yiyan Wang
- Department of statistics, University of Leeds, Leeds, England
| | - Jun Shen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center; Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, 160# Pu Jian Ave, Shanghai, 200127, China.
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Daperno M, Bortoli A, Kohn A, Politi P, Marconi S, Ardizzone S, Cortelezzi CC, Grasso G, Ferraris L, Milla M, Spina L, Guidi L, Losco A, Inserra G, Sablich R, Morganti D, Bodini G, Comberlato M. Patient and physician views on the quality of care for inflammatory bowel disease after one-year follow-up: Results from SOLUTION-2, a prospective IG-IBD study. Dig Liver Dis 2017; 49:997-1002. [PMID: 28595949 DOI: 10.1016/j.dld.2017.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Perception of quality of care is important in the management of patients with chronic diseases, particularly inflammatory bowel disease. AIMS AND METHODS This longitudinal study aimed to investigate variations of the Quality of Care through the Patients' Eyes (QUOTE-IBD) questionnaire scores one year after the basal evaluation in the Studio Osservazionale quaLità cUre malatTIe crOniche intestiNali (SOLUTION-1) study. RESULTS Of the cohort of 992 patients, 936 were evaluable. The QUOTE-IBD score overcame satisfactory levels of more than the 80%, overall and in all subdomains except for the "Continuity of Care" sub-dimension (mean, 8.3; standard deviation, 1.49), scored satisfactory only by 34% of the patients. No significant changes in satisfaction were recorded overall, or considering patients subgroups. Significant differences were found at the end of the follow-up between physicians' and patients' perceptions of quality of care, with the former over-rating their performance in "Continuity of Cares" and under-rating "Costs", "Competence", and "Accessibility" sub-domains of the score (p<0.05 for all). CONCLUSION Perceived quality of care in a large cohort of Italian patients with inflammatory bowel disease remains unchanged after one-year follow-up and was not significantly affected by disease activity or therapeutic interventions. Differences between physicians' and patients' perceptions of quality of care should be taken into account.
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Affiliation(s)
- Marco Daperno
- Department of Gastroenterology, Mauriziano Hospital, Turin, Italy.
| | | | - Anna Kohn
- Department of Gastroenterology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Stefano Marconi
- Medical Department, Chiesi Italian Pharmaceutical Group, Parma, Italy
| | - Sandro Ardizzone
- Gastroenterology Unit, L. Sacco University Hospital, Milan, ASST Fatebenefratelli Sacco, Italy
| | | | - Gianalberto Grasso
- Gastroenterology Unit, Carlo Ondoli Hospital, Angera, ASST Valle Olona, Italy
| | - Luca Ferraris
- Gastroenterology Unit, Gallarate Hospital, ASST Valleolona, Italy
| | - Monica Milla
- Gastroenterology Unit, University Hospital Careggi, Florence, Italy
| | - Luisa Spina
- Gastroenterology Department, IRCCS Policlinico San Donato Milanese, Italy
| | - Luisa Guidi
- Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli, Presidio Columbus, Rome, Italy
| | - Alessandra Losco
- Hepatology and Gastroenterology Department, San Paolo Hospital, Milan, ASST Santi Paolo e Carlo, Italy; Division of Internal Medicine, Liver and Gastroenterology Unit, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Gaetano Inserra
- Internal Medicine Unit, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico", Catania, Italy
| | - Renato Sablich
- Gastroenterology Unit, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Daniela Morganti
- Gastroenterology Unit, Garbagnate Milanese Hospital, ASST Rhodense, Italy
| | | | - Michele Comberlato
- Gastroenterology and Digestive Endoscopy Department, Bolzano Central Hospital, Italy
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Seo GS. [Quality of care in inflammatory bowel disease]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 65:139-44. [PMID: 25797376 DOI: 10.4166/kjg.2015.65.3.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Since inflammatory bowel disease (IBD) is a chronic and relapsing disorder, maintaining high quality of care plays an important role in the management of patients with IBD. To develop process-based quality indicator set to improve quality of care, the indicator should be based directly on evidence and consensus. Initially, ImproveCareNow group demonstrated quality improvement by learning how to apply quality improvement methods to improve the care of pediatric patients with IBD. The American Gastroenterological Association has developed adult IBD physician performance measures set and Crohn's and Colitis Foundation of America (CCFA) has developed a set of ten most highly rated process and outcome measures. Recently, The Emerging Practice in IBD Collaborative (EPIC) group generated defining quality indicators for best-practice management of IBD in Canada. Quality of Care through the Patient's Eyes (QUOTE-IBD) was developed as a questionnaire to measure quality of care through the eyes of patients with IBD, and it is widely used in European countries. The current concept of quality of care as well as quality indicator will be discussed in this article.
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Affiliation(s)
- Geom Seog Seo
- Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Korea
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Bortoli A, Daperno M, Kohn A, Politi P, Marconi S, Monterubbianesi R, Castiglione F, Corbellini A, Merli M, Casella G, D'Incà R, Orlando A, Bossa F, Doldo P, Lecis P, Valpiani D, Danese S, Comberlato M. Patient and physician views on the quality of care in inflammatory bowel disease: results from SOLUTION-1, a prospective IG-IBD study. J Crohns Colitis 2014; 8:1642-52. [PMID: 25113898 DOI: 10.1016/j.crohns.2014.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/29/2014] [Accepted: 07/13/2014] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Remarkable differences in quality of care (QoC) might be observed in different countries, affecting quality of life of inflammatory bowel disease (IBD) patients. The aim of this study was to assess patient and physician perceptions of the QoC in Italy. METHODS A multicentre observational study on the quality of care in IBD (SOLUTION-1) was conducted in 36 IG-IBD (Italian Group for Inflammatory Bowel Disease) centres in Italy. The QUOTE-IBD (Quality of Care Through the Patient's Eyes) questionnaire was administered to IBD patients and to the attending physicians. The Quality Impact (QI) score summarises the QUOTE-IBD questionnaire, and a QI >9 is considered satisfactory. RESULTS Nine-hundred-ninety-two patients and 75 physicians completed the QUOTE-IBD questionnaire. The patients scored the domains of competence (9.47 vs. 8.55) and costs (9.54 vs. 8.26) higher that the physicians, while information (9.31 vs. 9.43) and continuity of care (8.40 vs. 9.01) were scored lower. The QI score was rated worse by physicians with less experience (<12 years) with regard to competence (8.0 vs. 9.01), courtesy (8.12 vs. 10.0) and autonomy (8.97 vs. 10.0). Physicians considered the cost domain unsatisfactory. CONCLUSIONS Healthcare was rated as satisfactory overall for Italian patients and physicians. The physicians underestimate their competence and consider the cost of medical management unsatisfactory. The patients are more critical regarding the continuity of care and information. Country-specific data on QoC allow local governments to allocate resources more effectively.
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Affiliation(s)
- Aurora Bortoli
- Department of Gastroenterology and Digestive Endoscopy, A.O.G.Salvini, Rho Hospital, Italy.
| | - Marco Daperno
- Gastroenterology Unit, A.O. Ordine Mauriziano, Turin, Italy
| | - Anna Kohn
- Department of Gastroenterology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Stefano Marconi
- Medical Department, Chiesi Italian Pharmaceutical Group, Parma, Italy
| | | | | | - Ada Corbellini
- Department of Medicine, Vizzolo Predabissi Hospital, AO Melegnano,MI, Italy
| | - Manuela Merli
- II Department of Gastroenterology, "La Sapienza" University, Rome, Italy
| | | | - Renata D'Incà
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Italy
| | - Ambrogio Orlando
- Department of Medicine, Pneumology and Nutrition Clinic, "V. Cervello" Hospital, Ospedali Riuniti "Villa Sofia-Cervello" University of Palermo, Italy
| | - Fabrizio Bossa
- Gastroenterology Unit, CSS-IRCCS Hospital, San Giovanni Rotondo, Italy
| | - Patrizia Doldo
- Department of Gastroenterology and Digestive Endoscopy, University of Catanzaro, Italy
| | - Pierenrico Lecis
- Department of Gastroenterology and Digestive Endoscopy, San Martino Hospital, Belluno, Italy
| | - Daniela Valpiani
- Department of Gastroenterology and Digestive Endoscopy, Morgagni Hospital, Forlì, Italy
| | - Silvio Danese
- Gastroenterology Istituto Clinico Humanitas IRCCS, Rozzano,MI, Italy
| | - Michele Comberlato
- Gastroenterology and Digestive Endoscopy Departement, Bolzano Central Hospital, Italy
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Siegel CA, Allen JI, Melmed GY. Translating improved quality of care into an improved quality of life for patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2013; 11:908-12. [PMID: 23747710 DOI: 10.1016/j.cgh.2013.05.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 02/07/2023]
Abstract
The term quality of care has been interpreted in different ways in medicine. Skeptics of the quality movement insist that checkboxes and government and payer oversight will not lead to better patient outcomes. Supporters refer to areas in medicine in which quality improvement efforts have led to improved survival, such as in cystic fibrosis and cardiovascular disease. For quality improvement to be effective, the process demands rigorous documentation, analysis, feedback, and behavioral change. This requires valid metrics and mechanisms to provide dynamic point-of-care (or close to point of care) feedback in a manner that drives improvement. For inflammatory bowel disease, work has been performed in Europe and the United States to develop a framework for how practitioners can improve quality of care. Improve Care Now has created a sophisticated quality improvement program for pediatric patients with inflammatory bowel disease. The American Gastroenterology Association has worked within the National Quality Strategy framework to develop quality measures for patients with inflammatory bowel disease that have been incorporated into Federal programs that are moving Medicare reimbursement from a volume-based to a value-based structure. The Crohn's and Colitis Foundation of America is initiating a quality intervention program that can be implemented in community and academic practices to stimulate continual improvement processes for patients with inflammatory bowel disease. All of this work is intended to make quality improvement programs both feasible and useful, with the ultimate goal of improving quality of life for our patients.
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Affiliation(s)
- Corey A Siegel
- Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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Rejler M, Tholstrup J, Elg M, Spångéus A, Gäre BA. Framework for assessing quality of care for inflammatory bowel disease in Sweden. World J Gastroenterol 2012; 18:1085-92. [PMID: 22416183 PMCID: PMC3296982 DOI: 10.3748/wjg.v18.i10.1085] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/26/2011] [Accepted: 01/22/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To create and apply a framework for quality assessment and improvement in care for inflammatory bowel disease (IBD) patients. METHODS A framework for quality assessment and improvement was created for IBD based on two generally acknowledged quality models. The model of Donabedian (Df) offers a logistical and productive perspective and the Clinical Value Compass (CVC) model adds a management and service perspective. The framework creates a pedagogical tool to understand the balance between the dimensions of clinical care (CVC) and the components of clinical outcome (Df). The merged models create a framework of the care process dimensions as a whole, reflecting important parts of the IBD care delivery system in a local setting. Clinical and organizational quality measures were adopted from clinical experience and the literature and were integrated into the framework. Data were collected at the yearly check-up for 481 IBD patients during 2008. The application of the quality assessment framework was tested and evaluated in a local clinical IBD care setting in Jönköping County, Sweden. RESULTS The main outcome was the presentation of how locally-selected clinical quality measures, integrated into two complementary models to develop a framework, could be instrumental in assessing the quality of care delivered to patients with IBD. The selected quality measures of the framework noted less anemia in the population than previously reported, provided information about hospitalization rates and the few surgical procedures reported, and noted good access to the clinic. CONCLUSION The applied local quality framework was feasible and useful for assessing the quality of care delivered to IBD patients in a local setting.
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Juillerat P, Pittet V, Vader JP, Burnand B, Gonvers JJ, de Saussure P, Mottet C, Seibold F, Rogler G, Sagmeister M, Felley C, Michetti P, Froehlich F. Infliximab for Crohn's disease in the Swiss IBD Cohort Study: clinical management and appropriateness. Eur J Gastroenterol Hepatol 2010; 22:1352-7. [PMID: 20964261 DOI: 10.1097/meg.0b013e32833eaa8a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Antitumor necrosis factor a agents have significantly improved the management of Crohn's disease (CD), but not all patients benefit from this therapy. We used data from the Swiss Inflammatory Bowel Disease Cohort Study and predefined appropriateness criteria to examine the appropriateness of use of infliximab (IFX) in CD patients. METHODS EPACT II (European Panel on the Appropriateness of CD Therapy, 2007; www.epact.ch) appropriateness criteria have been developed using a formal explicit panel process combining evidence from the published literature and expert opinion. Questionnaires relating to EPACT II criteria were used at enrollment and follow-up of all Swiss Inflammatory Bowel Disease Cohort Study patients. A step-by-step analysis of all possible indications for IFX therapy in a given patient allowed identification of the most appropriate indication and final classification in a single appropriateness category (appropriate, uncertain, inappropriate). RESULTS Eight hundred and twenty-one CD patients were prospectively enrolled between November 2006 and March 2009. IFX was administered to 146 patients (18%) at enrollment and was most frequently used for complex fistulizing disease and for the maintenance of remission induced by biological therapy. IFX therapy was considered appropriate in 44%, uncertain in 44%, and inappropriate in 10% of patients. CONCLUSION In this cohort, 9 out of 10 indications for IFX therapy were clinically generally acceptable (appropriate or uncertain) according to EPACT II criteria. Uncertain indications resulted mainly from the current more liberal use of IFX in clinical practice as compared with the EPACT II criteria.
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Affiliation(s)
- Pascal Juillerat
- Department of Gastroenterology and Hepatology, Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
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