A Quality Improvement Initiative Is Associated With Reduced Time to Administer Biologics and Small Molecules and Emergency Room Visits in Inflammatory Bowel Disease

Abstract

Background: Delays in biologic or small molecule medication administration are associated with increased adverse events, hospitalization, and surgery in inflammatory bowel disease (IBD). We evaluated the impact of a quality improvement (QI) intervention on the time to administration of biologics or small molecules (TABS) in IBD. Methods: Data were retrospectively extracted for IBD patients prescribed biologics or small molecules from a convenience sample of providers participating in an accredited QI educational intervention (baseline cohort). Subsequent to the intervention, data were prospectively collected from patients prescribed these medications (postintervention cohort). Dates related to steps between a treatment decision to medication administration were collected. The primary outcome compared TABS in baseline and postintervention cohorts. Results: Eighteen physicians provided survey and patient data for 200 patients in each cohort (n=400). The median time to medication administration (TABS) decreased from baseline to postintervention cohorts (30 vs. 26 d, P=0.04). Emergency room visits before medication administration also decreased (25.5% vs. 12.5%, P=0.001). Similar numerical TABS reductions were observed in subgroups limited to physicians providing patients to both cohorts and for individual medications prescribed. Primary contributors to delays included filling prescriptions subsequent to insurance approval and dispensation subsequent to this. Conclusions: A QI intervention successfully reduced medication administration times (TABS) by accelerating provider-dependent steps. This intervention was associated with reduced emergency room visits. We propose TABS as a quality metric to assess the effective delivery of therapies in IBD. Further evaluation of QI interventions, patient education on prescription drug insurance, and quality metrics are warranted.

Quality improvement exercises in Inflammatory Bowel Disease (IBD) services: A scoping review

“…After the elimination of duplicates, 1515 titles and abstracts were evaluated for eligibility; 1385 were excluded. On review of 148 full texts, 100 studies were included: 35 peer reviewed publications [ 16 – 50 ] and 65 conference abstracts [ 51 – 115 ]. Fig 1 details reasons for rejection.…”

Barriers to optimizing inflammatory bowel disease care in the United States

“… 19 A quality improvement initiative within 18 adult IBD providers aimed at improving time-to-biologic- and small-molecule administration found that the insurance approval process step was not improved and actually lengthened over time despite their shortening time to medication administration by 4 days through streamlined internal processes. 20 Within the pediatric study, they examined the impact of medication delays on IBD-related healthcare utilization within 6 months from the delay, and those who required prior authorization had a 13% (95% CI: 2.5–23.4) increase in healthcare utilization after adjusting for demographics and disease-severity characteristics. 18 …”

Poor Clinician Adherence to Inflammatory Bowel Disease Guidelines: How Do We Remedy the Situation?

“…Physicians in private practice had greater than 75% compliance with every quality measure, while those in academic centers had 35%–100% compliance, with bone loss and vaccinations scoring lowest. 7 Battat et al 8 and Sapir et al 9 implemented QI-focused CME utilizing audit-feedback sessions to identify performance gaps in implementing IBD quality measures. 8 , 9 This led to addressing barriers to compliance and strategies to overcome them.…”

“… 7 Battat et al 8 and Sapir et al 9 implemented QI-focused CME utilizing audit-feedback sessions to identify performance gaps in implementing IBD quality measures. 8 , 9 This led to addressing barriers to compliance and strategies to overcome them. In Battat’s study, this was the first part of 3 components.…”

“…This intervention led to reduced medication administration time (for biologics and small molecules) and reduced emergency department visits for their patients. 8 …”