1
|
Ridsdale K, Khurana K, Taslim AT, Robinson JK, Solanke F, Tung WS, Sheldon E, Hind D, Lobo AJ. Quality improvement exercises in Inflammatory Bowel Disease (IBD) services: A scoping review. PLoS One 2024; 19:e0298374. [PMID: 38451904 PMCID: PMC10919633 DOI: 10.1371/journal.pone.0298374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/24/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE Quality Improvement initiatives aim to improve care in Inflammatory Bowel Disease (IBD). These address a range of aspects of care including adherence to published guidelines. The objectives of this review were to document the scope and quality of published quality improvement initiatives in IBD, highlight successful interventions and the outcomes achieved. DESIGN/METHOD We searched MEDLINE, EMBASE, CINAHL and Web of Science. Two reviewers independently screened and extracted data. We included peer reviewed articles or conference proceedings reporting initiatives intended to improve the quality of IBD care, with both baseline and prospectively collected follow-up data. Initiatives were categorised based on problems, interventions and outcomes. We used the Quality Improvement Minimum Quality Criteria Set instrument to appraise articles. We mapped the focus of the articles to the six domains of the IBD standards. RESULTS 100 studies were identified (35 full text; 65 conference abstracts). Many focused on vaccination, medication, screening, or meeting multiple quality measures. Common interventions included provider education, the development of new service protocols, or enhancements to the electronic medical records. Studies principally focused on areas covered by the IBD standards 'ongoing care' and 'the IBD service', with less focus on standards 'pre-diagnosis', 'newly diagnosed', 'flare management', 'surgery' or 'inpatient care'. CONCLUSION Good quality evidence exists on approaches to improve the quality of a narrow range of IBD service functions, but there are many topic areas with little or no published quality improvement initiatives. We highlight successful quality improvement interventions and offer recommendations to improve reporting of future studies.
Collapse
Affiliation(s)
- Katie Ridsdale
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - Kajal Khurana
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | | | | | - Faith Solanke
- Medical School, The University of Sheffield, Sheffield, United Kingdom
| | - Wei Shao Tung
- Medical School, The University of Sheffield, Sheffield, United Kingdom
| | - Elena Sheldon
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - Daniel Hind
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - Alan J. Lobo
- Sheffield Inflammatory Bowel Disease Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| |
Collapse
|
2
|
Patel J, Noureldin M, Fakhouri D, Farraye FA, Kovar-Gough I, Warren B, Waljee AK, Piper MS. Interventions Increase Vaccination Rates in Inflammatory Bowel Disease and Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Dig Dis Sci 2023; 68:2921-2935. [PMID: 37024741 PMCID: PMC10079156 DOI: 10.1007/s10620-023-07903-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/24/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Patients with immune-mediated conditions such as IBD and RA are at risk for vaccine-preventable infections. Despite guideline recommendations, prior studies have shown suboptimal vaccination rates. AIM We conducted a systematic review and meta-analysis to compare the different interventions intended to increase vaccination rates. METHODS A systematic search was conducted of MEDLINE/PubMed, Embase, CINAHL, and Cochrane Library up to 2020 for studies with interventions intended to increase vaccination rates. We performed a random-effects meta-analysis to generate pooled odds ratios (ORs) to assess all interventions against no interventions. Our primary outcome was pneumococcal vaccination (PCV) rate. RESULTS Our review found 8580 articles, for which 15 IBD and 8 RA articles met the inclusion criteria; 21 articles were included in the analysis. PCV was the predominant vaccination (91%). In our analysis of patients with IBD, almost all interventions (patient-oriented, physician-oriented, or barrier-oriented) increased PCV uptake [OR, 4.74; 95% CI, 2.44-6.56, I2 = 90%] compared to no intervention. The greatest effect was seen in barrier-oriented studies [OR, 12.68; 95% CI, 2.21-72.62, I2 = 92%]. For RA data, all interventions had increased PCV uptake compared to no interventions (OR 2.74; 95% CI, 1.80-4.17, I2 = 95%). CONCLUSION Our data suggest that many different interventions can increase PCV rates. It appears that barrier-oriented interventions may have the greatest positive effect on increasing PCV uptake. However, clinicians should be encouraged to implement measures best suited to their practice. Future high-quality randomized controlled trials are needed to determine the best approach to optimize vaccination rates.
Collapse
Affiliation(s)
- Jalpa Patel
- Division of Gastroenterology, Ascension Providence-Providence Park Hospital, Michigan State University College of Human Medicine, 16001 W. Nine Mile Road, Southfield, MI 48310 USA
| | - Mohamed Noureldin
- Division of Gastroenterology and Hepatology, University of Michigan Ann Arbor, Ann Arbor, MI 48109 USA
| | - Dina Fakhouri
- Division of Internal Medicine, Ascension Macomb-Oakland Macomb Campus, 1800 Twelve Mile Road, Warren, MI 48093 USA
| | - Francis A. Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic Inflammatory Bowel Disease Center, Jacksonville, FL 32224 USA
| | | | - Bradley Warren
- Division of Gastroenterology, Ascension Providence-Providence Park Hospital, Michigan State University College of Human Medicine, 16001 W. Nine Mile Road, Southfield, MI 48310 USA
| | - Akbar K. Waljee
- Division of Gastroenterology and Hepatology, University of Michigan Ann Arbor, Ann Arbor, MI 48109 USA
| | - Marc S. Piper
- Division of Gastroenterology, Ascension Providence-Providence Park Hospital, Michigan State University College of Human Medicine, 16001 W. Nine Mile Road, Southfield, MI 48310 USA
| |
Collapse
|
3
|
Fudman DI, Perez-Reyes AE, Niccum BA, Melmed GY, Khalili H. Interventions to Decrease Unplanned Healthcare Utilization and Improve Quality of Care in Adults With Inflammatory Bowel Disease: A Systematic Review. Clin Gastroenterol Hepatol 2022; 20:1947-1970.e7. [PMID: 34481951 DOI: 10.1016/j.cgh.2021.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Inflammatory bowel disease (IBD) care and outcomes exhibit substantial variability, suggesting quality gaps. We aimed to identify interventions to narrow these gaps. METHODS We performed a systematic review of Medline, Embase, and Web of Science through May 2021 to find manuscripts and abstracts reporting quality improvement (QI) interventions in IBD. We included studies with interventions that addressed acute care utilization, vaccination, or Crohn's and Colitis Foundation quality indicators for care processes, including pre-therapy testing, tobacco cessation, colorectal cancer surveillance, Clostridium difficile infection screening in flares, sigmoidoscopy in patients hospitalized with ulcerative colitis, and use of steroid-sparing therapy. The primary objective was to identify successful QI interventions. Risk of bias assessment was conducted using the Joanna Briggs Institute critical appraisal checklist. RESULTS Twenty-three manuscripts and 23 meeting abstracts met inclusion criteria. Influenza and pneumococcal vaccination were the most studied indicators (24 references), followed by emergency room and/or hospital utilization, tobacco cessation, and pre-therapy testing (17, 11, and 10 references, respectively). Electronic medical record-based interventions were the most frequent, whereas other initiatives used strategies that included changes to care structure or delivery, vaccination protocols, or physician and patient education. Successful interventions matched the complexity of the metric to the intervention including making changes to care structure or delivery, empowered non-physician staff, and used electronic medical record changes to prompt clinicians. CONCLUSIONS The quality of IBD care can be improved with diverse interventions that range from simple to complex. However, these interventions are not universally successful. Clinicians should emulate successful interventions and design new initiatives to narrow gaps in care quality.
Collapse
Affiliation(s)
- David I Fudman
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Andrea Escala Perez-Reyes
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Blake A Niccum
- Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Gil Y Melmed
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, New York, New York
| | - Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| |
Collapse
|
4
|
Yu N, Basnayake C, Connell W, Ding NS, Wright E, Stanley A, Fry S, Wilson-O'Brien A, Niewiadomski O, Lust M, Schulberg J, Kamm MA. Interventions to Improve Adherence to Preventive Care in Inflammatory Bowel Disease: A Systematic Review. Inflamm Bowel Dis 2022; 28:1177-1188. [PMID: 34618007 DOI: 10.1093/ibd/izab247] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Preventive health measures reduce treatment and disease-related complications including infections, osteoporosis, and malignancies in patients with inflammatory bowel disease (IBD). Although guidelines and quality measures for IBD care highlight the importance of preventive care, their uptake remains variable. This systematic review evaluates interventions aimed at improving the rates of provision and uptake of preventive health measures, including vaccinations, bone density assessment, skin cancer screening, cervical cancer screening, and smoking cessation counseling. METHODS We searched PubMed, MEDLINE, EMBASE, and CENTRAL for full text articles published until March 2021. Studies were included if they evaluated interventions to improve the provision or uptake of 1 or more preventive health measures in adult IBD patients and if they reported pre- and postintervention outcomes. RESULTS In all, 4655 studies were screened, and a total of 17 studies were included, including 1 randomized controlled trial, 1 cluster-controlled trial, and 15 prospective interventional studies. A variety of interventions were effective in improving the rates of adherence to preventive health measures. The most common interventions targeted gastroenterologists, including education, electronic medical records tools, and audit feedback. Other interventions targeted patients, such as education, questionnaires, and offering vaccine administration at clinic visits. Few interventions involved IBD nurses or primary care physicians. CONCLUSIONS A range of interventions-targeted at gastroenterologists, patients, or both-were effective in improving the provision and uptake of preventive care. Future studies should involve randomized controlled trials evaluating multifaceted interventions that target barriers to adherence and involve IBD nurses and primary care physicians.
Collapse
Affiliation(s)
- Natalie Yu
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Chamara Basnayake
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - William Connell
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Nik Sheng Ding
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Emily Wright
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Annalise Stanley
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Stephanie Fry
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Amy Wilson-O'Brien
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Ola Niewiadomski
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Mark Lust
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Julien Schulberg
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Michael A Kamm
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
5
|
Pyper M, Sidiqi A, Rogalla P, Sabbah S, Kielar A. CT Abdominal Tomography Indications: Are We All Sticking to the Plan? Can Assoc Radiol J 2020; 72:736-741. [PMID: 32903020 DOI: 10.1177/0846537120951078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Ultra-low radiation dose computed tomography (CT) abdominal tomography was introduced in our institution in 2016 to replace standard abdominal radiography in the investigation of emergency department patients. This project aims to ascertain whether investigation of emergency department patients using ultra-low radiation dose CT abdominal tomography complies with original indication guidelines and/or if there has been any "indication creep" 3 years after inception. METHODS Retrospective, quality assurance project with research ethics waiver. A review of 200 consecutive patients investigated with CT abdominal tomography between February and May 2017 was performed. This was compared with 200 consecutive patients investigated between February and May 2019. Data analyzed included patient demographics, indication for scan, as well as scan and patient outcomes. RESULTS In the 2017 group, 29/200 scans were noncompliant with approved indication guidelines. In the 2019 group, 30/200 scans were also noncompliant. There was no statistically significant difference between groups (P < .05) regarding the use of approved indications. Forty of 200 scans performed in 2017 revealed additional findings which are not specifically addressed on the reporting template. Forty-one of 200 scans in 2019 revealed these findings. CONCLUSIONS There has been no "indication creep" for CT abdominal tomography over time.
Collapse
Affiliation(s)
- Michael Pyper
- Toronto General Hospital, Toronto, ON, Canada.,Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | | | | | - Sam Sabbah
- Toronto General Hospital, Toronto, ON, Canada
| | - Ania Kielar
- Toronto General Hospital, Toronto, ON, Canada
| |
Collapse
|
6
|
Bensinger A, Wilson F, Green P, Bloomfeld R, Dharod A. Sustained Improvement in Inflammatory Bowel Disease Quality Measures Using an Electronic Health Record Intervention. Appl Clin Inform 2019; 10:918-926. [PMID: 31801173 DOI: 10.1055/s-0039-3400293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a chronic condition with wide variation in treatment and resource utilization because of many different disease presentations and treatment options. In an effort to standardize care and improve health outcomes, several organizations have created performance measures to monitor various aspects of IBD care. OBJECTIVES We aimed to assess longitudinal documentation adherence with physician quality reporting system's (PQRS) IBD performance measures before, immediately after, and 1 year following the implementation of a comprehensive electronic health record (EHR) IBD clinical documentation support tool intervention. METHODS We reviewed 50 patient charts that were randomly selected from consecutive outpatient IBD visits at our tertiary care center from September 1, 2015 to June 30, 2016, prior to implementation of an IBD-specific note template, order set, and patient education handout on September 1, 2016. Two additional cohorts of 50 patient charts were randomly selected from September 1, 2016 to June 30, 2017 and September 1, 2017 to June 30, 2018. These charts were reviewed to assess adherence of pertinent PQRS performance measures for outpatient IBD care. The project was deemed not human subjects research and received exempt approval by the Institutional Review Board (IRB#: IRB00040399). RESULTS The cohort immediately after the intervention showed significant increases in documentation rates of influenza immunization (19-59%, p < 0.001), pneumococcal immunizations (2-38%, p < 0.001), tobacco cessation (28.6-77.8%, p = 0.049), and proportion of all eligible measures (40.6-62.2%, p < 0.001) when compared with the preintervention group. Moreover, documentation rates were sustained in the 1-year follow-up group when compared with the postintervention group. CONCLUSION A multifaceted, EHR focused approach can significantly and sustainably improve documentation of outpatient IBD quality measures.
Collapse
Affiliation(s)
- Andrew Bensinger
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, United States
| | - Farra Wilson
- Department of Internal Medicine, Section on Gastroenterology, Wake Forest University School of Medicine, Winston Salem, North Carolina, United States
| | - Patrick Green
- Department of Internal Medicine, Section on Gastroenterology, Wake Forest University School of Medicine, Winston Salem, North Carolina, United States
| | - Richard Bloomfeld
- Department of Internal Medicine, Section on Gastroenterology, Wake Forest University School of Medicine, Winston Salem, North Carolina, United States
| | - Ajay Dharod
- Department of Internal Medicine, Section on General Internal Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, United States
| |
Collapse
|
7
|
Improving treatment of patients with inflammatory bowel diseases: a controlled trial of a multifaceted intervention in two German cities. Int J Colorectal Dis 2019; 34:1233-1240. [PMID: 31127363 DOI: 10.1007/s00384-019-03317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Many recommendations from clinical practice guidelines are not implemented. We aimed to develop and evaluate a multifaceted strategy for the implementation of guidelines for Crohn's disease (CD) and ulcerative colitis (UC). METHODS In the intervention region (Berlin, Germany), a continuing medical education course was held, brief guidelines for practice were distributed to all family physicians and gastroenterologists, and patient guidelines were distributed to all surveyed patients. Educational outreach visits with local opinion leaders were also conducted. No specific interventions were performed in the control region (Hamburg, Germany). Prior to the intervention and 1 year later, 1900 members of three statutory sickness funds were asked about their treatment according to guidelines with (1) long-term aminosalicylates and (2) immunosuppressants, (3) whether they took long-term glucocorticoids for maintenance of remission, (4) if they smoked, in CD patients, and (5) about the surveillance colonoscopies, in UC patients. RESULTS Response rate after implementation was 20.1%. Responders differed between intervention and control region by age and by distribution between patients with UC or CD. After 1 year, more patients were treated according to clinical practice guidelines in the control region than in the intervention region. More patients in the intervention region took immunosuppressants after 1 year, and fewer had a surveillance colonoscopy. However, no before-after comparison was statistically significant. CONCLUSIONS This implementation strategy of UC and CD guidelines did not result in a statistically significant effect. Future implementation of guidelines for inflammatory bowel disease might need thorough evaluation of barriers and the support of theory-based concepts.
Collapse
|
8
|
Georgy M, Negm Y, El-Matary W. Quality improvement in healthcare for patients with inflammatory bowel disease. Transl Pediatr 2019; 8:77-82. [PMID: 30881901 PMCID: PMC6382498 DOI: 10.21037/tp.2019.01.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Since inflammatory bowel diseases (IBD) are chronic disorders with typical remission and relapses and no cure, maintaining high quality of provided healthcare to patients with IBD plays a major role in the management and reducing disease-related morbidity. To hone process-based quality indicators in order to ameliorate quality of care, the indicators must be based on high quality evidence and expert consensus. ImproveCareNow (ICN) group gave us a great example of quality improvement (QI) by gaining experience in how to exercise, apply and implement QI methods in the care of children with IBD. "The American Gastroenterological Association" has developed an adult "IBD physician performance measures set" and both "Crohn's and Colitis Foundation of America" (CCFA) and "Crohn's and Colitis Canada" (CCC) have developed sets of most highly rated process and outcome measures. "The Emerging Practice in IBD Collaborative (EPIC) Canadian group" developed definitions of quality indicators for best-practice management of IBD in Canada. "Quality of Care through the Patient's Eyes (QUOTE-IBD)" was honed as a questionnaire to quantify quality of care in the eyes of patients with IBD. This is now widely used in several European countries. The current concepts of quality of care as well as quality indicators will be discussed in this article.
Collapse
Affiliation(s)
- Michael Georgy
- Section of Pediatric Gastroenterology, Winnipeg Children's Hospital, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Yasser Negm
- Section of Pediatric Gastroenterology, Winnipeg Children's Hospital, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Wael El-Matary
- Section of Pediatric Gastroenterology, Winnipeg Children's Hospital, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| |
Collapse
|
9
|
Reynolds C, Esrailian E, Hommes D. Quality Improvement in Gastroenterology: A Systematic Review of Practical Interventions for Clinicians. Dig Dis Sci 2018; 63:2507-2518. [PMID: 30014225 DOI: 10.1007/s10620-018-5198-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/05/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Quality improvement (QI) identifies practical methods to improve patient care; however, it is not always widely known which QI methods are successful. We sought to create a primer of QI in gastroenterology for the practicing clinician. METHODS We performed a systematic review of QI literature in gastroenterology. We included search terms for inflammatory bowel disease, irritable bowel syndrome, celiac disease, gastroesophageal reflux disease, pancreatitis, liver disease, colorectal cancer screening, endoscopy, and gastrointestinal bleeding. We used general search terms for QI as well as specific terms to capture established quality metrics for each GI disease area. RESULTS We found 33 studies that met our definitions for QI. There were 17 studies of endoscopy including screening colonoscopy, six on liver disease, four on IBD, two on GERD, three on GI bleeding, and one on celiac disease. Education was the most common intervention, although most successful studies combined education with another intervention. Other effective interventions included retraining sessions to reach ADR goals in colonoscopy, nursing protocols to increase HCC screening, and EMR decision support tools to prompt reassessment of PPI therapy. Many studies showed improved compliance to metrics, but few were able to show differences in length of stay, readmissions, or mortality. CONCLUSIONS Our review of quality improvement literature in gastroenterology revealed common themes of successful programs: Education was frequently used but often insufficient, the EMR may be underutilized in guiding decision making, and patient-reported outcomes were infrequently assessed. Further research may be needed to compare QI strategies directly.
Collapse
Affiliation(s)
- Courtney Reynolds
- Division of Digestive Diseases, Department of Medicine, University of California Los Angeles, 10945 Le Conte Ave, Suite 2338, Los Angeles, CA, 90095, USA.
| | - Eric Esrailian
- Division of Digestive Diseases, Department of Medicine, University of California Los Angeles, 10945 Le Conte Ave, Suite 2338, Los Angeles, CA, 90095, USA.,Division of Digestive Diseases, Department of Medicine, University of California Los Angeles, 200 Medical Plaza Driveway, Los Angeles, CA, 90024, USA
| | - Daniel Hommes
- Division of Digestive Diseases, Department of Medicine, University of California Los Angeles, 10945 Le Conte Ave, Suite 2338, Los Angeles, CA, 90095, USA
| |
Collapse
|
10
|
Bilal M, Singh S, Lee H, Khosa K, Khehra R, Clarke K. Bridges to excellence quality indicators in inflammatory bowel disease (IBD): differences between IBD and non-IBD gastroenterologists. Ann Gastroenterol 2016; 30:192-196. [PMID: 28243040 PMCID: PMC5320032 DOI: 10.20524/aog.2016.0114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/28/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The American Gastroenterology Association (AGA) Bridges to Excellence (BTE) Inflammatory Bowel Disease (IBD) Care Recognition program encourages clinicians to develop a superior quality of care in the treatment of IBD. We evaluated adherence to BTE measures in the care of IBD patients among IBD and non-IBD gastrointestinal physicians at a tertiary care hospital. METHODS We performed a retrospective chart analysis of IBD patients who had received care at our center between January 2013 and March 2015. The patients were divided into two groups: a. care provided by an IBD-trained physician with more than 50% of their practice dedicated to IBD; and b. care provided by a non-IBD gastrointestinal physician. Data collected included baseline patient characteristics and eight BTE measures. Overall adherence to BTE measures and average scores as per the AGA 100 point scale were evaluated and compared between the two groups. RESULTS A total of 325 IBD patients met the inclusion criteria and were included in the analysis. Of these, 216 patients received care from an IBD physician. Patients managed by IBD physicians were younger and had more severe disease. Both physician groups scored above the recommended score of 60. IBD physicians had a higher average score on the AGA 100 point scale (73.9 vs 66.3, P=0.001). Overall adherence to BTE quality measures was higher for IBD physicians compared to non-IBD physicians (71.8% vs. 58.8%, P value: 0.001). CONCLUSION Both IBD and non-IBD physicians exceeded the AGA recommended score of 60 on the BTE measures at our center. IBD physicians perform better overall on BTE quality measures compared to non-IBD physicians.
Collapse
Affiliation(s)
- Mohammad Bilal
- Department of Internal Medicine (Mohammad Bilal, Kiranpreet Khosa, Kofi Clarke)
| | - Shailendra Singh
- Division of Gastroenterology, Hepatology and Nutrition (Shailendra Singh, Helen Lee, Kiranpreet Khosa, Raman Khehra, Kofi Clarke), Allegheny General Hospital, Pittsburgh, PA, USA
| | - Helen Lee
- Division of Gastroenterology, Hepatology and Nutrition (Shailendra Singh, Helen Lee, Kiranpreet Khosa, Raman Khehra, Kofi Clarke), Allegheny General Hospital, Pittsburgh, PA, USA
| | - Kiranpreet Khosa
- Division of Gastroenterology, Hepatology and Nutrition (Shailendra Singh, Helen Lee, Kiranpreet Khosa, Raman Khehra, Kofi Clarke), Allegheny General Hospital, Pittsburgh, PA, USA
| | - Raman Khehra
- Division of Gastroenterology, Hepatology and Nutrition (Shailendra Singh, Helen Lee, Kiranpreet Khosa, Raman Khehra, Kofi Clarke), Allegheny General Hospital, Pittsburgh, PA, USA
| | - Kofi Clarke
- Department of Internal Medicine (Mohammad Bilal, Kiranpreet Khosa, Kofi Clarke); Division of Gastroenterology, Hepatology and Nutrition (Shailendra Singh, Helen Lee, Kiranpreet Khosa, Raman Khehra, Kofi Clarke), Allegheny General Hospital, Pittsburgh, PA, USA
| |
Collapse
|
11
|
Sapir T, Moreo K, Carter JD, Greene L, Patel B, Higgins PDR. Continuing Medical Education Improves Gastroenterologists' Compliance with Inflammatory Bowel Disease Quality Measures. Dig Dis Sci 2016; 61:1862-9. [PMID: 26873536 DOI: 10.1007/s10620-016-4061-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 01/26/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Low rates of compliance with quality measures for inflammatory bowel disease (IBD) have been reported for US gastroenterologists. AIMS We assessed the influence of quality improvement (QI) education on compliance with physician quality reporting system (PQRS) measures for IBD and measures related to National Quality Strategy (NQS) priorities. METHODS Forty community-based gastroenterologists participated in the QI study; 20 were assigned to educational intervention and control groups, respectively. At baseline, randomly selected charts of patients with moderate-to-severe ulcerative colitis were retrospectively reviewed for the gastroenterologists' performance of 8 PQRS IBD measures and 4 NQS-related measures. The intervention group participated in a series of accredited continuing medical education (CME) activities focusing on QI. Follow-up chart reviews were conducted 6 months after the CME activities. Independent t tests were conducted to compare between-group differences in baseline-to-follow-up rates of documented compliance with each measure. RESULTS The analysis included 299 baseline charts and 300 follow-up charts. The intervention group had significantly greater magnitudes of improvement than the control group for the following measures: assessment of IBD type, location, and activity (+14 %, p = 0.009); influenza vaccination (+13 %, p = 0.025); pneumococcal vaccination (+20 %, p = 0.003); testing for latent tuberculosis before anti-TNF-α therapy (+10 %, p = 0.028); assessment of hepatitis B virus status before anti-TNF-α therapy (+9 %, p = 0.010); assessment of side effects (+17 %, p = 0.048), and counseling patients about cancer risks (+13 %, p = 0.013). CONCLUSIONS QI-focused CME improves community-based gastroenterologists' compliance with IBD quality measures and measures aligned with NQS priorities.
Collapse
Affiliation(s)
- Tamar Sapir
- PRIME Education, Inc., 8201 West McNab Road, Tamarac, FL, 33321, USA.
| | - Kathleen Moreo
- PRIME Education, Inc., 8201 West McNab Road, Tamarac, FL, 33321, USA
| | - Jeffrey D Carter
- PRIME Education, Inc., 8201 West McNab Road, Tamarac, FL, 33321, USA
| | - Laurence Greene
- PRIME Education, Inc., 8201 West McNab Road, Tamarac, FL, 33321, USA
| | - Barry Patel
- Indegene Total Therapeutic Management, 300 Townpark Dr #100, Kennesaw, GA, 30144, USA
| | - Peter D R Higgins
- Department of Gastroenterology, University of Michigan Health System, 1500 E Medical Center Dr # 391, Ann Arbor, MI, 48109, USA
| |
Collapse
|
12
|
Moreo K, Greene L, Sapir T. Improving Interprofessional and Coproductive Outcomes of Care for Patients with Chronic Obstructive Pulmonary Disease. BMJ QUALITY IMPROVEMENT REPORTS 2016; 5:bmjquality_uu210329.w4679. [PMID: 27335647 PMCID: PMC4916605 DOI: 10.1136/bmjquality.u210329.w4679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/01/2016] [Indexed: 01/16/2023]
Abstract
In the U.S., suboptimal care quality for patients with chronic obstructive pulmonary disease (COPD) is reflected by high rates of emergency department visits and hospital readmissions, as well as excessive costs. Moreover, a substantial proportion of COPD patients do not receive guideline-directed therapies. In quality improvement (QI) programs, these types of health care problems are commonly addressed through interventions that primarily or exclusively support physicians in aligning their practices with guidelines and clinical quality measures. However, the root causes of many deficits in health care quality are not necessarily “physician centric.” Instead, they often involve suboptimal collaboration among members of interprofessional health care teams and gaps in coproductive relationships among patients and providers. We conducted a QI project to identify interprofessional and coproductive correlates of COPD care quality in the context of a continuing education program designed to advance knowledge and skill among patients, providers, and the interprofessional COPD team regarding coproductive COPD care. Participants in the program included providers in 30 primary care practices across the U.S. who, along with their own COPD patients and a separate cohort of patients from COPD advocacy groups, completed a patient-provider survey study designed to identify alignments and mismatches in coproductive perceptions and behaviors, a private survey feedback session for each practice's team, and online/mobile educational activities on COPD. In addition, more than 1,000 additional providers and 200 patients participated in just the online/mobile education. From the patient perspective, baseline measures indicated a high rate of dissatisfaction with COPD treatment plans and suboptimal coproductive interaction with members of the interprofessional health care team. Across providers, there were gaps and variation in provision of patient education, attitudes and practices regarding shared decision-making, and care coordination with pulmonary specialists. In addition, relatively low proportions of providers reported high levels of skill in various coproductive processes. The project outcomes indicated mismatches between COPD patients and providers in perceived ability to recognize COPD exacerbations, shared treatment goals, barriers to medication adherence, perceived impact of COPD on quality of life, and other aspects of COPD care. Providers demonstrated improvements in knowledge and attitudes regarding coproductive and coordinated COPD care.
Collapse
|
13
|
Moreo K, Sapir T, Greene L. Applying Quality Improvement into Systems-based Learning to Improve Diabetes Outcomes in Primary Care. BMJ QUALITY IMPROVEMENT REPORTS 2015; 4:bmjquality_uu208829.w3999. [PMID: 26734436 PMCID: PMC4693094 DOI: 10.1136/bmjquality.u208829.w3999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 09/09/2015] [Indexed: 12/18/2022]
Abstract
In the U.S., where the prevalence of type 2 diabetes has reached epidemic proportions, many patients with this disease are treated by primary care physicians in community-based systems, including accountable care organisations (ACOs). To address gaps in the quality of diabetes care, national quality measures have been established, including patient-centered measures adopted by the Centers for Medicare and Medicaid Services for its Shared Savings Program for ACOs. From a patient-centered perspective, high-quality diabetes care depends on effective communication between clinicians and patients, along with patient education and counseling about medications and lifestyle. We designed and implemented a quality improvement (QI) program for 30 primary care physicians treating patients with type 2 diabetes in three structurally similar but geographically diverse ACOs. Retrospective chart audits were conducted before (n = 300) and after (n = 300) each physician participated in accredited continuing medical education (CME) courses that focused on QI strategies. Randomly selected charts were audited to measurably assess essential interventions for improved outcomes in type 2 diabetes including the physicians’ documentation of patient counseling and assessment of side effects, and patients’ medication adherence status and changes in hemoglobin A1C (A1C) and body mass index (BMI). Paced educational interventions included a private performance improvement Internet live course conducted for each physician, small-group Internet live courses involving peer discussion, and a set of enduring materials, which were also multi-accredited for all clinicians in the physician's practice. Continual improvement cycles were guided by analysis of the baseline chart audits, quantitative survey data, and qualitative feedback offered by participants. To extend the benefit of the education, the enduring materials were offered to the interprofessional team of clinicians throughout the U.S. who did not participate in the QI program. For brevity, this article presents outcomes of the 30 primary care physicians. Baseline to post-education improvements were observed for percentages of charts with documented assessment of medication side effects (+11%) and counseling about medication risks/benefits (+28%), medication adherence (+13%), and lifestyle modifications (+8%). Improvements were also observed for documented adherence to diabetes medications (+24%) and first-to-last visit changes in A1C (−0.16%) and BMI (−2.1). The findings indicate a positive influence of QI education on primary care physicians’ performance of patient-centered quality measures and patient outcomes.
Collapse
|