Melmed GY, Oliver B, Hou JK, Lum D, Singh S, Crate D, Almario C, Bray H, Bresee C, Gerich M, Gerner D, Heagy E, Holthoff M, Hudesman D, McCutcheon Adams K, Mattar MC, Metwally M, Nelson E, Ostrov A, Rubin DT, Scott F, Samir S, van Deen W, Younes Z, Oberai R, Weaver A, Siegel CA; IBD Qorus. Quality of Care Program Reduces Unplanned Health Care Utilization in Patients With Inflammatory Bowel Disease.
Am J Gastroenterol 2021;
116:2410-8. [PMID:
34797226 DOI:
10.14309/ajg.0000000000001547]
[Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/27/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION
There is significant variation in processes and outcomes of care for patients with inflammatory bowel disease (IBD), suggesting opportunities to improve quality of care. We aimed to determine whether a structured quality of care program can improve IBD outcomes, including the need for unplanned health care utilization.
METHODS
We used a structured approach to improve adult IBD care in 27 community-based gastroenterology practices and academic medical centers. Patient-reported outcomes (PRO) and health care utilization were collected at clinical visits. Outcomes were monitored monthly using statistical process control charts; improvement was defined by special cause (nonrandom) variation over time. Multivariable logistic regression was applied to patient-level data. Nineteen process changes were offered to improve unplanned health care utilization. Ten outcomes were assessed, including disease activity, remission status, urgent care need, recent emergency department use, hospitalizations, computed tomography scans, health confidence, corticosteroid or opioid use, and clinic phone calls.
RESULTS
We collected data prospectively from 20,382 discrete IBD visits. During the 15-month project period, improvement was noted across multiple measures, including need for urgent care, hospitalization, steroid use, and opioid utilization. Adjusted multivariable modeling showed significant improvements over time across multiple outcomes including urgent care need, health confidence, emergency department utilization, hospitalization, corticosteroid use, and opioid use. Attendance at monthly coached webinars was associated with improvement.
DISCUSSION
Outcomes of IBD care were improved using a structured quality improvement program that facilitates small process changes, sharing of best practices, and ongoing feedback. Spread of these interventions may facilitate broad improvement in IBD care when applied to a large population.
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