Abstract
Background and Aims
Quality metrics allows health care to be standardized and monitored. The American Gastroenterological Association (AGA) established quality metrics for inflammatory bowel disease (IBD) in 2011, but compliance is unknown.
Methods
Patients with IBD seen in the gastroenterology clinics at a tertiary care medical center during April 2013 were included. Charts were reviewed for the current state of compliance with the publicized AGA measures over the prior 12 months. Records were assessed for type of IBD, year of diagnosis, number of medications, comorbidities, hospitalizations and gastroenterology clinic visits in the last year, presence of primary care physician (PCP) at the institution, and involvement of a specialist in IBD or a trainee. Univariate and multivariate logistic regression analyses were done using SPSS.
Results
Only 6.5 % (24/367) of patients had all applicable core measures documented. In univariate analysis, year of IBD diagnosis (p = 0.014), number of comorbidities (p = 0.024), seen by a specialist in IBD (p = 0.002), seen by a gastroenterology fellow or resident (p = 0.034), and having a PCP at the institution (p = 0.006) were significant. In multivariate analysis, seen by a specialist in IBD (5.36, 95 % CI 1.22–23.63, p = 0.027), having a PCP at the institution (3.24, 95 % CI 1.23–8.54, p = 0.018), and year of IBD diagnosis (0.967, 95 % CI 0.937–0.999, p = 0.042) remained significant. Screening for tobacco abuse was the most frequently assessed (96 %, n = 352/367) core measure, while pneumococcal immunization (21 %, n = 76/367) was the least.
Conclusion
Our study demonstrates poor compliance with IBD quality metrics. Additional studies are needed to determine the causes of failure to comply with the quality metrics.
Similar content being viewed by others
Abbreviations
- ACA:
-
Affordable Care Act
- AGA:
-
American Gastroenterological Association
- Anti-TNF:
-
Anti-tumor necrosis factor
- BIDMC:
-
Beth Israel Deaconess Medical Center
- CMS:
-
Centers for Medicare and Medicaid Services
- EHR:
-
Electronic health record
- IBD:
-
Inflammatory bowel disease
- IOM:
-
Institute of Medicine
- GI:
-
Gastroenterology
- PCP:
-
Primary care physician
References
Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA. 1998;280:1000–1005.
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;11:908–912.
Center for Medicare and Medicaid Services. Medicare and Medicaid Ehr Incentive Program Basics. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Basics.html; 2013 Accessed November 26, 2013.
Physician Quality Measue Reporting. http://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-improvement/clinical-quality/physician-quality-reporting-system.page. Accessed October 15, 2013.
A Conceptual Use to Meanginful Use. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf; 2013 Accessed October 15, 2013.
Bates DW, Gawande AA. Improving Safety with Information Technology. N Engl J Med. 2003;348:2526–2534.
Cebul RD, Love TE, Jain AK, Hebert CJ. Electronic health records and quality of diabetes care. N Engl J Med. 2011;365:825–833.
American Gastroenterological Association. Adult inflammatory bowel disease Physician Performance Measures Set. http://www.gastro.org/practice/quality-initiatives/IBD_Measures.pdf; 2011 Accessed August 2, 2013.
McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med.. 2003;348:2635–2645.
The Physician Quality Reporting System (Pqrs). http://www.gastro.org/practice/quality-initiatives/cms-physician-qualitative-report-initiative. Accessed October 15, 2013.
Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142:260–273.
Stille CJ, Jerant A, Bell D, Meltzer D, Elmore JG. Coordinating care across diseases, settings, and clinicians: a key role for the generalist in practice. Ann Intern Med. 2005;142:700–708.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Feuerstein, J.D., Lewandowski, J.J., Martinez-Vazquez, M. et al. Documented Compliance with Inflammatory Bowel Disease Quality Measures Is Poor. Dig Dis Sci 60, 339–344 (2015). https://doi.org/10.1007/s10620-014-3385-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-014-3385-y