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Quality Improvement in Inflammatory Bowel Disease

  • Jeremy AdlerEmail author
  • Richard B. Colletti
  • Wallace V. Crandall
  • Peter A. Margolis
Chapter

Abstract

Health services research suggests that health care could perform a great deal better than it does today. To improve the care of patients requires more than knowledge; achievement of improvements requires the application of the principles of continuous quality improvement. One of the barriers to quality improvement is unnecessary variation in care. Unnecessary variation, which erodes quality and reliability and adds to costs, is derived in part from habitual differences in practice style that are not grounded in knowledge or reason. Quality improvement efforts can reduce unnecessary variation. To attain continuous quality improvement in health care, it is necessary to repeatedly measure the processes and outcomes of care, design and implement interventions to improve the processes of care, and remeasure to determine the effect of the interventions. The road map of translational research begins with basic biomedical science and advances to clinical efficacy knowledge, to clinical effectiveness knowledge, and finally to improved health-care quality and value. Measurement and accountability of health-care quality and cost, implementation of interventions and health-care system redesign, and scaling and spread of effective interventions are necessary to transform the health-care system. In this chapter, we present an introduction to quality improvement and how it can apply to pediatric inflammatory bowel disease, with brief discussions of variation in care, the chronic illness care model, the need for quality improvement, the improvement model, the improvement collaborative, and the ImproveCareNow Network.

Keywords

Pediatric Crohn disease Ulcerative colitis Inflammatory bowel disease Quality improvement Health services research Implementation science Variation in care Chronic care Collaborative network 

References

  1. 1.
    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;348:2635–45.CrossRefPubMedGoogle Scholar
  2. 2.
    Mangione-Smith R, DeCristofaro AH, Setodji CM, et al. The quality of ambulatory care delivered to children in the United States. N Engl J Med. 2007;357:1515–23.CrossRefPubMedGoogle Scholar
  3. 3.
    Jha AK, Li Z, Orav EJ, et al. Care in U.S. hospitals – the Hospital Quality Alliance program. N Engl J Med. 2005;353:265–74.CrossRefPubMedGoogle Scholar
  4. 4.
    Institute of Medicine (U.S.) Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington,(DC): National Academy Press; 2001.Google Scholar
  5. 5.
    Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012;307:1513–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Berwick DM, Nolan TW. Physicians as leaders in improving health care: a new series in Annals of Internal Medicine. Ann Intern Med. 1998;128:289–92.CrossRefPubMedGoogle Scholar
  7. 7.
    Clemmer TP, Spuhler VJ, Berwick DM, et al. Cooperation: the foundation of improvement. Ann Intern Med. 1998;128:1004–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Berwick DM. Controlling variation in health care: a consultation from Walter Shewhart. Med Care. 1991;29:1212–25.CrossRefPubMedGoogle Scholar
  9. 9.
    Ferguson Jr TB, Peterson ED, Coombs LP, et al. Use of continuous quality improvement to increase use of process measures in patients undergoing coronary artery bypass graft surgery: a randomized controlled trial. JAMA. 2003;290:49–56.CrossRefPubMedGoogle Scholar
  10. 10.
    Adler J, Sandberg KC, Shpeen BH, et al. Variation in infliximab administration practices in the treatment of pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2013;57:35–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Colletti RB, Baldassano RN, Milov DE, et al. Variation in care in pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2009;49:297–303.CrossRefPubMedGoogle Scholar
  12. 12.
    Kappelman MD, Bousvaros A, Hyams J, et al. Intercenter variation in initial management of children with Crohn's disease. Inflamm Bowel Dis. 2007;13:890–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Donovan M, Lunney K, Carter-Pokras O, et al. Prescribing patterns and awareness of adverse effects of infliximab: a health survey of gastroenterologists. Dig Dis Sci. 2007;52:1798–805.CrossRefPubMedGoogle Scholar
  14. 14.
    Konstan MW, Butler SM, Schidlow DV, et al. Patterns of medical practice in cystic fibrosis: part II. Use of therapies. Investigators and Coordinators of the Epidemiologic Study of Cystic Fibrosis. Pediatr Pulmonol. 1999;28:248–54.CrossRefPubMedGoogle Scholar
  15. 15.
    Morgan WJ, Butler SM, Johnson CA, et al. Epidemiologic study of cystic fibrosis: design and implementation of a prospective, multicenter, observational study of patients with cystic fibrosis in the U.S. and Canada. Pediatr Pulmonol. 1999;28:231-241Google Scholar
  16. 16.
    Konstan MW, Butler SM, Schidlow DV, et al. Patterns of medical practice in cystic fibrosis: part I. Evaluation and monitoring of health status of patients. Investigators and Coordinators of the Epidemiologic Study of Cystic Fibrosis. Pediatr Pulmonol. 1999;28:242–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288:1775–9.CrossRefPubMedGoogle Scholar
  18. 18.
  19. 19.
    Provost LP. Analytical studies: a framework for quality improvement design and analysis. BMJ Qual Saf. 2011;20(Suppl 1):i92–6.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Portela MC, Pronovost PJ, Woodcock T, et al. How to study improvement interventions: a brief overview of possible study types. BMJ Qual Saf. 2015;24:325–36.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Deming WE. Out of the Crisis. Cambridge: MIT Center for Advanced Engineering Study; 1982.Google Scholar
  22. 22.
    Grove AS. Efficiency in the health care industries: a view from the outside. JAMA. 2005;294:490–2.CrossRefPubMedGoogle Scholar
  23. 23.
    Imai M. The key to Japan’s competitive success. New York: McGraw-Hill Publishing Company; 1986.Google Scholar
  24. 24.
    Schouten LM, Hulscher ME, van Everdingen JJ, et al. Evidence for the impact of quality improvement collaboratives: systematic review. BMJ. 2008;336:1491–4.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Tsai AC, Morton SC, Mangione CM, et al. A meta-analysis of interventions to improve care for chronic illnesses. Am J Manag Care. 2005;11:478–88.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Nightingale AJ, Middleton W, Middleton SJ, et al. Evaluation of the effectiveness of a specialist nurse in the management of inflammatory bowel disease (IBD). Eur J Gastroenterol Hepatol. 2000;12:967–73.CrossRefPubMedGoogle Scholar
  27. 27.
    Kennedy AP, Nelson E, Reeves D, et al. A randomised controlled trial to assess the effectiveness and cost of a patient orientated self management approach to chronic inflammatory bowel disease. Gut. 2004;53:1639–45.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Fitzgerald MF, Mitton SG, Protheroe A, et al. The organisation and structure of inflammatory bowel disease services for children and young people in the UK in 2010: significant progress but still room for improvement. Frontline Gastroenterol. 2012;4:25–31.CrossRefGoogle Scholar
  29. 29.
    Phan VA, Langenberg D, Grafton R, et al. A dedicated inflammatory bowel disease service quantitatively and qualitatively improves outcomes in less than 18 months: a prospective cohort study in a large metropolitan centre. Frontline Gastroenterol. 2012;3:137–42.CrossRefGoogle Scholar
  30. 30.
    Wolters FL, Russel MG, Stockbrugger RW. Systematic review: has disease outcome in Crohn's disease changed during the last four decades? Aliment Pharmacol Ther. 2004;20:483–96.CrossRefPubMedGoogle Scholar
  31. 31.
    Nguyen GC, Tuskey A, Dassopoulos T, et al. Rising hospitalization rates for inflammatory bowel disease in the United States between 1998 and 2004. Inflamm Bowel Dis. 2007;13:1529–35.CrossRefPubMedGoogle Scholar
  32. 32.
    Sandberg KC, Davis MM, Gebremariam A, et al. Increasing hospitalizations in inflammatory bowel disease among children in the United States, 1988-2011. Inflamm Bowel Dis. 2014;20:1754–60.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Peyrin-Biroulet L, Lemann M. Review article: remission rates achievable by current therapies for inflammatory bowel disease. Aliment Pharmacol Ther. 2011;33:870–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Reddy SI, Friedman S, Telford JJ, et al. Are patients with inflammatory bowel disease receiving optimal care? Am J Gastroenterol. 2005;100:1357–61.CrossRefPubMedGoogle Scholar
  35. 35.
    de Bie CI, Buderus S, Sandhu BK, et al. Diagnostic workup of paediatric patients with inflammatory bowel disease in Europe: results of a 5-year audit of the EUROKIDS registry. J Pediatr Gastroenterol Nutr. 2012;54:374–80.CrossRefPubMedGoogle Scholar
  36. 36.
    Ball JE, Osbourne J, Jowett S, et al. Quality improvement programme to achieve acceptable colonoscopy completion rates: prospective before and after study. BMJ. 2004;329:665–7.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    de Lange T, Moum BA, Tholfsen JK, et al. Standardization and quality of endoscopy text reports in ulcerative colitis. Endoscopy. 2003;35:835–40.CrossRefPubMedGoogle Scholar
  38. 38.
    Johanson JF. Continuous quality improvement in the ambulatory endoscopy center. Gastrointest Endosc Clin N Am. 2002;12:351–65.CrossRefPubMedGoogle Scholar
  39. 39.
    O'Connor JB, Sondhi SS, Mullen KD, et al. A continuous quality improvement initiative reduces inappropriate prescribing of prophylactic antibiotics for endoscopic procedures. Am J Gastroenterol. 1999;94:2115–21.CrossRefPubMedGoogle Scholar
  40. 40.
    Robertson DJ, Lawrence LB, Shaheen NJ, et al. Quality of colonoscopy reporting: a process of care study. Am J Gastroenterol. 2002;97:2651–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Rogers A, Kennedy A, Nelson E, et al. Patients' experiences of an open access follow up arrangement in managing inflammatory bowel disease. Qual Saf Health Care. 2004;13:374–8.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Seematter-Bagnoud L, Vader JP, Wietlisbach V, et al. Overuse and underuse of diagnostic upper gastrointestinal endoscopy in various clinical settings. Int J Qual Health Care J Int Soc Qual Health Care / ISQua. 1999;11:301–8.CrossRefGoogle Scholar
  43. 43.
    Zebris J, Maurer W. Quality assurance in the endoscopy suite: sedation and monitoring. Gastrointest Endosc Clin N Am. 2004;14:415–29.CrossRefPubMedGoogle Scholar
  44. 44.
    Matharoo M, Thomas-Gibson S, Haycock A, et al. Implementation of an endoscopy safety checklist. Frontline Gastroenterol. 2014;5:260–5.CrossRefPubMedGoogle Scholar
  45. 45.
    Wallaert JB, De Martino RR, Marsicovetere PS, et al. Venous thromboembolism after surgery for inflammatory bowel disease: are there modifiable risk factors? Data from ACS NSQIP. Dis Colon rectum. 2012;55:1138–44.Google Scholar
  46. 46.
    Gross ME, Vogler SA, Mone MC, et al. The importance of extended postoperative venous thromboembolism prophylaxis in IBD: a National Surgical Quality Improvement Program analysis. Dis Colon rectum. 2014;57:482–9.Google Scholar
  47. 47.
    Brotman M, Allen JI, Bickston SJ, et al. AGA Task Force on Quality in Practice: a national overview and implications for GI practice. Gastroenterology. 2005;129:361–9.CrossRefPubMedGoogle Scholar
  48. 48.
    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 : Off Clin Practice J Am Gastroenterol Ass. 2013;11:908–12.CrossRefGoogle Scholar
  49. 49.
    Melmed GY, Siegel CA. Quality improvement in inflammatory bowel disease. Gastroenterol Hepatol. 2013;9:286–92.Google Scholar
  50. 50.
    Langley GJ. The improvement guide : a practical approach to enhancing organizational performance. 2nd ed. San Francisco: Jossey-Bass; 2009.Google Scholar
  51. 51.
    Vos L, Duckers ML, Wagner C, et al. Applying the quality improvement collaborative method to process redesign: a multiple case study. Implement Sci: IS. 2010;5:19.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Institute for Healthcare Improvement. The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement, IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003.Google Scholar
  53. 53.
    Rogers EM. Diffusion of innovations. 5th ed. New York: Free Press; 2003.Google Scholar
  54. 54.
    Travaglia JF, Nugus PI, Greenfield D, et al. Visualising differences in professionals' perspectives on quality and safety. BMJ Qual Saf. 2012;21:778–83.CrossRefPubMedGoogle Scholar
  55. 55.
    Crandall W, Kappelman MD, Colletti RB, et al. ImproveCareNow: The development of a pediatric inflammatory bowel disease improvement network. Inflamm Bowel Dis. 2011;17:450–7.CrossRefPubMedGoogle Scholar
  56. 56.
    Crandall WV, Boyle BM, Colletti RB, et al. Development of process and outcome measures for improvement: lessons learned in a quality improvement collaborative for pediatric inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:2184–91.CrossRefPubMedGoogle Scholar
  57. 57.
    Marsolo K, Margolis PA, Forrest CB, et al. A Digital Architecture for a Network-Based Learning Health System: Integrating Chronic Care Management, Quality Improvement, and Research. EGEMS. 2015;3:1168.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Kappelman MD, Crandall WV, Colletti RB, et al. Short pediatric Crohn's disease activity index for quality improvement and observational research. Inflamm Bowel Dis. 2011;17:112–7.CrossRefPubMedGoogle Scholar
  59. 59.
    Dotson JL, Crandall WV, Zhang P, et al. Feasibility and validity of the pediatric ulcerative colitis activity index in routine clinical practice. J Pediatr Gastroenterol Nutr. 2015;60:200–4.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Turner D, Hyams J, Markowitz J, et al. Appraisal of the pediatric ulcerative colitis activity index (PUCAI). Inflamm Bowel Dis. 2009;15:1218–23.CrossRefPubMedGoogle Scholar
  61. 61.
    Crandall WV, Margolis PA, Kappelman MD, et al. Improved outcomes in a quality improvement collaborative for pediatric inflammatory bowel disease. Pediatrics. 2012;129:e1030–41.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Billett AL, Colletti RB, Mandel KE, et al. Exemplar pediatric collaborative improvement networks: achieving results. Pediatrics. 2013;131(Suppl 4):S196–203.CrossRefPubMedGoogle Scholar
  63. 63.
    Forrest CB, Margolis P, Seid M, et al. PEDSnet: how a prototype pediatric learning health system is being expanded into a national network. Health Aff. 2014;33:1171–7.CrossRefGoogle Scholar
  64. 64.
    Lee GJ, Kappelman MD, Boyle B, et al. Role of sex in the treatment and clinical outcomes of pediatric patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2012;55:701–6.CrossRefPubMedGoogle Scholar
  65. 65.
    Boyle BM, Palmer L, Kappelman MD. Quality of health care in the United States: implications for pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2009;49:272–82.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Margolis P, Provost LP, Schoettker PJ, et al. Quality improvement, clinical research, and quality improvement research--opportunities for integration. Pediatr Clin North Am. 2009;56:831–41.CrossRefPubMedGoogle Scholar
  67. 67.
    Dougherty D, Conway PH. The “3 T's” road map to transform US health care: the “how” of high-quality care. JAMA. 2008;299:2319–21.Google Scholar
  68. 68.
    Porter ME, Long Jr JH. Vertebrae in compression: Mechanical behavior of arches and centra in the gray smooth-hound shark (Mustelus californicus). J Morphol. 2010;271:366–75.PubMedGoogle Scholar
  69. 69.
    Park KT, Crandall WV, Fridge J, et al. Implementable strategies and exploratory considerations to reduce costs associated with anti-TNF therapy in inflammatory bowel disease. Inflamm Bowel Dis. 2014;20:946–51.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Kappelman MD, Dorn SD, Peterson E, et al. Quality of care for gastrointestinal conditions: a primer for gastroenterologists. Am J Gastroenterol. 2011;106:1182–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Jeremy Adler
    • 1
    Email author
  • Richard B. Colletti
    • 2
    • 3
  • Wallace V. Crandall
    • 4
  • Peter A. Margolis
    • 5
  1. 1.Department of Pediatrics and Communicable DiseasesPediatric Inflammatory Bowel Disease Program, C.S. Mott Children’s Hospital, University of Michigan Health SystemAnn ArborUSA
  2. 2.Department of PediatricsUniversity of Vermont College of MedicineBurlingtonUSA
  3. 3.ImproveCareNowBurlingtonUSA
  4. 4.Department of PediatricsThe Ohio State University College of Medicine, Center for Pediatric and Adolescent Inflammatory Bowel Disease, Nationwide Children’s HospitalColumbusUSA
  5. 5.James M. Anderson Center for Health System Excellence, Cincinnati Children’s Hospital Medical CenterCincinnatiUSA

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