Crohn's & Colitis Australia inflammatory bowel disease audit: measuring the quality of care in Australia

Abstract

Background Australia has among the highest prevalence of Crohn disease and ulcerative colitis in the world. Management of the chronic gastrointestinal disorders results in significant societal costs and the standard of care is inconsistent across Australia. Aim To audit the quality of care received by patients admitted for inflammatory bowel disease (IBD) across Australia against national IBD standards. Methods A retrospective cross‐sectional survey and clinical audit was undertaken assessing organisational resources, clinical processes and outcome measures. This study was conducted in Australian hospitals that care for inpatients with Crohn disease or ulcerative colitis. The main outcome measures were adherence to national IBD standards and comparison of quality of care between hospitals with and without multidisciplinary IBD services. Results A total of 71 hospitals completed the organisational survey. Only one hospital had a complete multidisciplinary IBD service and 17 had a partial IBD service (IBD nurse, helpline and clinical lead). A total of 1440 inpatient records was reviewed from 52 hospitals (mean age 37 years; 51% female, 53% Crohn disease), approximately 26% of IBD inpatient episodes over a 12‐month period in Australia. These patients were chronically unwell with high rates of anaemia (30%) and frequent readmissions (40% within 2 years). In general, care was inconsistent, and documentation was poor. Hospitals with a partial IBD service performed better in many processes and outcome measures: for example, 22% reduction in admissions through emergency departments and greater adherence to standards for safety monitoring of biological (89% vs 59%) and immunosuppressive drugs (79% vs 55%) in those hospitals than those without. Conclusion Patients admitted to hospital suffering from IBD are young, chronically unwell and are subject to substantial variations in clinical documentation and quality of care. Only one hospital met accepted standards for multidisciplinary care; hospitals with even a minimal IBD service provided improved care.

Psychological distress is highly prevalent in inflammatory bowel disease: A survey of psychological needs and attitudes

“…A previous Australian study using the same measure of distress (K10) ( n = 336) documented clinically significant levels in 52% of respondents. A national audit of IBD hospital care identified that “mental health condition” was the most common comorbid condition and affected more than a quarter of hospitalized patients. Less than a quarter of these patients received psychological support in hospital.…”

“…Data on patient needs and access to psychological services in IBD are scarce. A national audit of IBD hospital care found a major gap in the access to multidisciplinary services, including psychology support, but the data for mental health services outside inpatient care are lacking. The present survey was designed to describe the levels of distress in people with IBD, as well as the needs, attitudes, and access to psychological services for people with IBD in Australia against established Australian IBD Standards, which recommend psychological screening for all IBD patients, access to mental health services for inpatient assessment, and treatment and coordination of psychological treatment with primary care mental health services (Standard A13).…”

Quality of care in inflammatory bowel disease: actual health service experiences fall short of the standards

“…However, a recent national audit of hospital-and clinician-based IBD care led by Crohn's & Colitis Australia (CCA) found it to fall short of national standards. 6,7 A major gap was identified in access to multidisciplinary services, including psychological support. Of note, those IBD services with even a partial IBD-Team, defined as a clinical lead, some IBD nurse time and a helpline, provided improved care compared to those that did not.…”

Nationwide improvement in outcomes of emergency admission for ulcerative colitis in England, 2005‐2013

“…There is growing international interest in quality improvement and benchmarking of IBD care within individual health care systems and between countries . The UK IBD Audit has served as a model for a recent national programme in Australia . However, the interpretation of trends in outcomes from serial UK audits is difficult owing to differences in site participation and case ascertainment between audit rounds and different hospitals.…”