Establishing key performance indicators for inflammatory bowel disease in the UK

Quraishi, Mohammed Nabil; Dobson, Elizabeth; Ainley, Rachel; Din, Shahida; Wakeman, Ruth; Cummings, Fraser; Sebastian, Shaji; Bloom, Stuart; Limdi, Jimmy K.; Dhar, Anjan; Speight, R Alexander; Bodger, Keith; Kennedy, Nicholas A; Lamb, Christopher A; Arnott, Ian; Selinger, Christian P.

doi:10.1136/flgastro-2023-102409

Cited by 7 publications

(2 citation statements)

References 24 publications

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“…9 10 Moreover, time to diagnosis following referral has recently been established as a key performance indicator for IBD. 11 With burgeoning waiting lists for suspected IBD patients, effective triage of referrals from primary care is vital. A well-established tool to support this is faecal calprotectin (FCP) testing in primary care.…”

Section: What This Study Addsmentioning

confidence: 99%

Optimising triage of urgent referrals for suspected IBD: results from the Birmingham IBD inception study

Rimmer,

Cheesbrough,

Harris

et al. 2024

Frontline Gastroenterol

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ObjectiveDiagnostic delays in inflammatory bowel disease (IBD) result in adverse outcomes. We report a bespoke diagnostic pathway to assess how best to combine clinical history and faecal calprotectin (FCP) for early diagnosis and efficient resource utilisation.MethodsA rapid-access pathway was implemented for suspected IBD patients referred outside urgent ‘two-week wait’ criteria. Patients were triaged using symptoms and FCP. A 13-point symptom history was taken prediagnosis and clinical indices, including repeat FCP, collected prospectively.ResultsOf 767 patients (January 2021–August 2023), 423 were diagnosed with IBD (208 Crohn’s disease (CD), 215 ulcerative colitis (UC)). Most common symptoms in CD were abdominal pain (84%), looser stools (84%) and fatigue (79%) and in UC per-rectal bleeding (94%), urgency (82%) and looser stools (81%). Strongest IBD predictors were blood mixed with stools (CD OR 4.38; 95% CI 2.40–7.98, UC OR 33.68; 15.47–73.33) and weight loss (CD OR 3.39; 2.14–5.38, UC OR 2.33; 1.37–4.00). Repeat FCP testing showed reduction from baseline in non-IBD. Both measurements >100 µg/g (area under the curve (AUC) 0.800) and >200 µg/g (AUC 0.834) collectively predicted IBD. However, a second value ≥220 µg/g considered alone, regardless of the first result, was more accurate (Youden’s index 0.735, AUC 0.923). Modelling symptoms with FCP increased AUC to 0.947.ConclusionSerial FCP measurement prevents unnecessary colonoscopy. Two FCPs >200 µg/g could stream patients direct to colonoscopy, with two >100 µg/g prompting clinic review. A second result ≥220 µg/g was more accurate than dual-result thresholds. Coupling home FCP testing with key symptoms may form the basis of effective self-referral pathways.

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Section: What This Study Addsmentioning

confidence: 99%

Optimising triage of urgent referrals for suspected IBD: results from the Birmingham IBD inception study

Rimmer,

Cheesbrough,

Harris

et al. 2024

Frontline Gastroenterol

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“…The British Society of Gastroenterology has recently published four IBD KPIs including 1) time from referral to diagnosis, 2) time from diagnosis to treatment, 3) steroid use, and 4) advanced therapy safety screening and efficacy assessments. (14) These will allow longitudinal assessments of services but require regular data collection for repeated audit cycles.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of emergency hospital admissions for inflammatory bowel disease as a possible marker of quality of care of British IBD inflammatory bowel disease units

Selinger,

Bottle,

Lamb

et al. 2024

Frontline Gastroenterol

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BackgroundKey performance indicators (KPIs) are required to facilitate quality improvement for inflammatory bowel disease (IBD). Emergency admissions for IBD may represent a possible KPI.MethodsIBD emergency admissions for 2018–2019 from Hospital Episodes Statistics for England were compared per population and per IBD cases with patient-reported quality of care from the IBD Patient Survey 2019. Patient-reported accident and emergency (A&E) attendances and hospital admissions for IBD were also compared with patient-reported quality of care.ResultsFor 124 IBD services within England we found only a weak and not statistically significant correlation between IBD admissions per 100 000 population and patient-rated quality of care (Spearman’s rho=0.171; p=0.057). Similarly, there was no significant correlation between IBD admissions per case and patient-rated quality of care (Spearman’s rho=0.164; p=0.113). Patients with ≥2 A&E attendances (OR: 0.72, 95% CI: 0.57 to 0.91; p<0.001) were less likely to report quality of IBD care as good or very good compared with those without A&E attendances. Patients with ≥2 admissions were less likely to rate their care as good or very good (OR: 0.75, 95% CI: 0.65 to 0.88; p<0.0001) compared with those without hospital admissions.ConclusionsThere is a clear association for individual patients with ≥2 admissions or A&E attendances with a lower perceived quality of care. In contrast we found no correlation on a per-unit basis for IBD admissions derived from Hospital Episode Statistics with patient-assessed quality of care. Further work is required to determine whether hospital admissions could be a useful KPI for IBD.

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Inflammatory bowel disease has no borders: engaging patients as partners to deliver global, equitable and holistic health care

Lamb,

Titterton,

Banerjee

et al. 2024

The Lancet

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Establishing key performance indicators for inflammatory bowel disease in the UK

Cited by 7 publications

References 24 publications

Optimising triage of urgent referrals for suspected IBD: results from the Birmingham IBD inception study

Optimising triage of urgent referrals for suspected IBD: results from the Birmingham IBD inception study

Evaluation of emergency hospital admissions for inflammatory bowel disease as a possible marker of quality of care of British IBD inflammatory bowel disease units

Inflammatory bowel disease has no borders: engaging patients as partners to deliver global, equitable and holistic health care

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