Interventions to Decrease Unplanned Healthcare Utilization and Improve Quality of Care in Adults With Inflammatory Bowel Disease: A Systematic Review

Fudman, David; Perez-Reyes, Andrea Escala; Niccum, Blake; Melmed, Gil Y.; Khalili, Hamed

doi:10.1016/j.cgh.2021.08.048

Cited by 10 publications

(8 citation statements)

References 75 publications

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“…Despite efforts to standardise care, there still appears to be variation in clinical practice, much of which is unwarranted [118]. This review complements the more focused work of Fudman and colleagues [12] in offering a broader evidence base for improvement strategies in IBD. From that review and our own, there is now a sound evidence base for improvement approaches to several problems.…”

Section: Implications For Patients Clinicians and Policy Makersmentioning

confidence: 81%

“…From that review and our own, there is now a sound evidence base for improvement approaches to several problems. Some interventions were complex, such as formation of a new rapid access clinic [ 24 ] or creating new job roles [ 12 , 23 ], but many studies employed less time and resource intensive approaches, such as educational sessions. Common interventions included: patient educational handouts; different forms of learning sessions aimed at providers; posters or flyers in clinics; improvement of the pre-visit planning processes; standardised order sets; enhancements to the EMR system; and updates to, or development of new, decision aids and guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…Systematic overviews can help improve planning quality improvement projects by summarising what is already known and where there are evidence deficits [ 11 ]. A recent systematic review focused on publications addressing US quality metrics for adult IBD [ 12 ]. It found that successful approaches empowered non-physicians, targeted multidisciplinary teams, prompted clinicians using Electronic Medical Records (EMR) and restructured care delivery.…”

Section: Introductionmentioning

confidence: 99%

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

Ridsdale,

Khurana,

Taslim

et al. 2024

PLoS ONE

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Objective Quality Improvement initiatives aim to improve care in Inflammatory Bowel Disease (IBD). These address a range of aspects of care including adherence to published guidelines. The objectives of this review were to document the scope and quality of published quality improvement initiatives in IBD, highlight successful interventions and the outcomes achieved. Design/method We searched MEDLINE, EMBASE, CINAHL and Web of Science. Two reviewers independently screened and extracted data. We included peer reviewed articles or conference proceedings reporting initiatives intended to improve the quality of IBD care, with both baseline and prospectively collected follow-up data. Initiatives were categorised based on problems, interventions and outcomes. We used the Quality Improvement Minimum Quality Criteria Set instrument to appraise articles. We mapped the focus of the articles to the six domains of the IBD standards. Results 100 studies were identified (35 full text; 65 conference abstracts). Many focused on vaccination, medication, screening, or meeting multiple quality measures. Common interventions included provider education, the development of new service protocols, or enhancements to the electronic medical records. Studies principally focused on areas covered by the IBD standards ‘ongoing care’ and ‘the IBD service’, with less focus on standards ‘pre-diagnosis’, ‘newly diagnosed’, ‘flare management’, ‘surgery’ or ‘inpatient care’. Conclusion Good quality evidence exists on approaches to improve the quality of a narrow range of IBD service functions, but there are many topic areas with little or no published quality improvement initiatives. We highlight successful quality improvement interventions and offer recommendations to improve reporting of future studies.

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Section: Implications For Patients Clinicians and Policy Makersmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Ridsdale,

Khurana,

Taslim

et al. 2024

PLoS ONE

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“…9 Although physician education can be an affordable and realistic strategy for reducing corticosteroid use, a previous study reported that physician education has a limited role in the treatment of IBD such as increasing vaccination rates and the performance of tests that must be conducted prior to administration of biologics. 10 However, this study highlighted the important role of physician education in reducing corticosteroid use and suggested a new way to correct the pattern of corticosteroid use, which plays a direct and important impact in IBD treatment. By establishing clinical strategies that consider potential risk factors for corticosteroid excess and educating physicians, we expect to reduce unnecessary corticosteroid use, which could ultimately lead to improved IBD treatment.…”

mentioning

confidence: 94%

“…There are few steroid-sparing agents, and the high financial burden and low accessibility of steroid-sparing agents are also important factors to consider when devising a strategy to reduce corticosteroid use practically [ 9 ]. Although physician education can be an affordable and realistic strategy for reducing corticosteroid use, a previous study reported that physician education has a limited role in the treatment of IBD such as increasing vaccination rates and the performance of tests that must be conducted prior to administration of biologics [ 10 ]. However, this study highlighted the important role of physician education in reducing corticosteroid use and suggested a new way to correct the pattern of corticosteroid use, which plays a direct and important impact in IBD treatment.…”

mentioning

confidence: 99%

Corticosteroid, a double-edged sword in inflammatory bowel disease management: possibility of reducing corticosteroid use through physician education

Kim

Koh

2022

Intest Res

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also recommends that oral steroids should not be provided as first-line therapy in mild to moderate ulcerative colitis (UC), and if corticosteroids are used as the first-line induction therapy for moderate to severe Crohn' s disease (CD), a gradual dose reduction is advised. 6 In this issue of Intestinal Research, Park et al. 7 conducted "A retrospective Chart review to observe The use of steroids In managing patients with inflammatory bowel disease iN South Korea (ACTION)" to investigate the current status of steroid use in the treatment of IBD in South Korea and to evaluate the effect of educating physicians on excessive and/or inappropriate steroid use using a cohort of patients with IBD recruited from 5 centers across the representative geographic regions of South Korea from May 14, 2018, to July 18, 2019. Of the 1,685 participants (660 CD and 1,025 UC), 9.2% (n = 155) experienced steroid exposure in the past 12 months, of which 29.7% (n = 46) had excessive steroid use and 10.3% (n = 16) had inappropriate steroid use. When compared according to disease type, the overall steroid exposure rate was higher in UC patients than in CD patients (10.7% vs. 6.8%), and the frequency of steroid dependency (69.1% vs. 57.8%) and excessive steroid use (34.6% vs. 17.8%) were also higher in UC patients than in CD patients, respectively. The authors also evaluated the impact of physician education on steroid use by constructing another cohort 1 year after physical education, and the frequency of excessive steroid use (from 29.7% to 20%), steroid dependency (from

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Monitoring Postoperative Crohn’s Disease—Closing the Gap

Fudman

2023

Dig Dis Sci

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Interventions to Decrease Unplanned Healthcare Utilization and Improve Quality of Care in Adults With Inflammatory Bowel Disease: A Systematic Review

Cited by 10 publications

References 75 publications

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

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

Corticosteroid, a double-edged sword in inflammatory bowel disease management: possibility of reducing corticosteroid use through physician education

Monitoring Postoperative Crohn’s Disease—Closing the Gap

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