Quality Improvement Initiatives in Inflammatory Bowel Disease
- 445 Downloads
Purpose of Review
This article serves as an overview of several quality improvement initiatives in inflammatory bowel disease (IBD).
IBD is associated with significant variation in care, suggesting poor quality of care. There have been several efforts to improve the quality of care for patients with IBD. Quality improvement (QI) initiatives in IBD are intended to be patient-centric, improve outcomes for individuals and populations, and reduce costs—all consistent with “the triple aim” put forth by the Institute for Healthcare Improvement (IHI).
Current QI initiatives include the development of quality measure sets to standardize processes and outcomes, learning health systems to foster collaborative improvement, and patient-centered medical homes specific to patients with IBD in shared risk models of care. Some of these programs have demonstrated early success in improving patient outcomes, reducing costs, improving patient satisfaction, and facilitating patient engagement. However, further studies are needed to evaluate and compare the effects of these programs over time on clinical outcomes in order to demonstrate long-term value and sustainability.
KeywordsGastroenterology Inflammatory bowel disease Quality improvement Quality measures Learning health system Specialty medical home
Compliance with Ethical Standards
Conflict of Interest
Gil Melmed and Corey Siegel serve as co-chairs of the Crohn’s & Colitis Foundation of America’s Quality of Care committee and are co-Principal Investigators of IBD Qorus.
Sameer Berry declares no conflict of interest.
Gil Melmed reports honoraria received from Abbvie, Celgene, Janssen, Pfizer, Takeda, Samsung Bioepis and UCB as a consultant; and grant from Prometheus.
Corey Siegel reports honoraria received from Abbvie, Amgen, Celgene, Lilly, Janssen, Sandoz, Pfizer, Prometheus, Takeda, and UCB as a consultant; grants or grants pending from CCFA, AHRQ (1R01HS021747-01), Abbvie, Janssen, Pfizer, and Takeda; fees paid by American Regent, Abbvie, Janssen, Pfizer, and Takeda for speaking for CME programs; and patents by for a “System and Method of Communicating Predicted Medical Outcomes,” filed 3/34/10, by Dartmouth-Hitchcock Medical Center and Cedars-Sinai Medical Center. Dr. Siegel is an inventor.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Mehta F. Report: economic implications of inflammatory bowel disease and its management. Am J Manag Care. 2016;22:s51–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27269903
- 3.• Weaver KN, Kappelman MD, Sandler RS. Variation in care of inflammatory bowel diseases patients in Crohnʼs and Colitis Foundation of America Partners. Inflamm Bowel Dis. 2016;22(11):2672–7. This article provides recent and objective data about the variation in IBD care by GI physicians. It also explains how variation in care is an indication of low quality care CrossRefPubMedGoogle Scholar
- 7.Kaplan GG, McCarthy EP, Ayanian JZ, Korzenik J, Hodin R, Sands BE. Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology. 2008;134:680–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/182426047 CrossRefPubMedGoogle Scholar
- 9.The IHI Triple Aim [Internet]. The IHI Triple Aim. [cited 2016 Dec 26]. Available from: http://www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx
- 10.• Melmed GY, Siegel CA, Spiegel BM, Allen JI, Cima R, Colombel JF, et al. Quality indicators for inflammatory bowel disease: development of process and outcome measures. Inflamm Bowel Dis. 2013;19(3):662–8. This article goes into detail as to how the process and outcome measures were created which is important because it may lay the groundwork for further QI intiatives and future process/outcome measure sets CrossRefPubMedGoogle Scholar
- 11.ICHOM—International Consortium for Health Outcomes Measurement [Internet]. ICHOM International Consortium for Health Outcomes Measurement. [cited 2016 Dec 26]. Available from: http://www.ichom.org/medical-conditions/inflammatory-bowel-disease/.
- 12.Calvet X, Panés J, Alfaro N, Hinojosa J, Sicilia B, Gallego M, et al. Delphi consensus statement: Quality indicators for inflammatory bowel disease comprehensive care units. J Crohn’s Colitis. Elsevier B.V. 2014;8:240–51. Available from: http://dx.doi.org/10.1016/j.crohns.2013.10.010 CrossRefGoogle Scholar
- 13.Nguyen GC, Devlin SM, Afif W, Bressler B, Gruchy SE, Kaplan GG, et al. Defining quality indicators for best-practice management of inflammatory bowel disease in Canada. Can J Gastroenterol Hepatol. 2014;28:275–85. Available from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L373341873.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Smith M, Saunders R, Stuckhardt L, McGinnis JM, Best care at lower cost: the path to continuously learning health care in America [Internet]. Comm Learn Heal Care Syst Am Inst Med. 2012. Available from: http://www.cro3.org/cgi/doi/10.5860/CHOICE.51-3277.
- 15.ImproveCareNow [Internet]. ImproveCareNow. [cited 2016 Dec 26]. Available from: http://www.improvecarenow.org/.
- 17.IBD Qorus: Quality driven. Care focused. [Internet]. CCFA: IBD Qorus: Quality driven. Care focused. [cited 2016 Dec 26]. Available from: http://www.ccfa.org/science-and-professionals/ibdqorus/.
- 18.What is a medical home? Why is it important? [Internet]. What is a medical home? Why is it important? [cited 2016 Dec 26]. Available from: https://www.hrsa.gov/healthit/toolbox/Childrenstoolbox/BuildingMedicalHome/whyimportant.html.
- 19.• Regueiro MD, McAnallen SE, Greer JB, Perkins SE, Ramalingam S, Szigethy E. The inflammatory bowel disease specialty medical home: a new model of patient-centered care. Inflamm Bowel Dis. 2016;22:1971–80. This article describes the concept of a subspecialty medical home for patients with inflammatory bowel disease, including comprehensive, multidisciplinary care and a novel shared savings program CrossRefPubMedGoogle Scholar
- 20.IBD medical homes dramatically cut ED visits, hospitalizations [Internet]. IBD medical homes dramatically cut ED visits, hospitalizations | PM360. [cited 2017 Jan 2]. Available from: https://www.pm360online.com/ibd-medical-homes-dramatically-cut-ed-visits-hospitalizations/.
- 22.Kosinski, Lawrence R. MD. Project Sonar: a solution for change. EndoEconomics. 2015;5–7.Google Scholar