Quality of Care Program Reduces Unplanned Health Care Utilization in Patients With Inflammatory Bowel Disease

Abstract

There is significant variation in processes and outcomes of care for patients with inflammatory bowel disease (IBD), suggesting opportunities to improve quality of care. We aimed to determine whether a structured quality of care program can improve IBD outcomes, including the need for unplanned health care utilization. METHODS:We used a structured approach to improve adult IBD care in 27 community-based gastroenterology practices and academic medical centers. Patient-reported outcomes (PRO) and health care utilization were collected at clinical visits. Outcomes were monitored monthly using statistical process control charts; improvement was defined by special cause (nonrandom) variation over time. Multivariable logistic regression was applied to patient-level data. Nineteen process changes were offered to improve unplanned health care utilization. Ten outcomes were assessed, including disease activity, remission status, urgent care need, recent emergency department use, hospitalizations, computed tomography scans, health confidence, corticosteroid or opioid use, and clinic phone calls. RESULTS:We collected data prospectively from 20,382 discrete IBD visits. During the 15-month project period, improvement was noted across multiple measures, including need for urgent care, hospitalization, steroid use, and opioid utilization. Adjusted multivariable modeling showed significant improvements over time across multiple outcomes including urgent care need, health confidence, emergency department utilization, hospitalization, corticosteroid use, and opioid use. Attendance at monthly coached webinars was associated with improvement.

Editorial: progress towards more comprehensively understanding the sources of corticosteroids for patients with IBD

“…However, there could be an emphasis on improved "urgent" follow-up with gastroenterology; improving this access is a focus of some quality improvement initiatives such as IBD Qorus. 8 Under such a model, corticosteroid use could be reviewed and modified in a timely manner, and escalation of steroid-sparing therapy could be expedited. Another vital avenue of curbing corticosteroid use would be continued expansion of primary care educational efforts regarding appropriate IBD speciailty care consultation and judicious corticosteroid use.…”

“…Corticosteroid prescriptions for acute disease flares could be deferred to IBD specialists, although this is unrealistic when patients often initially interact with primary or urgent care providers. However, there could be an emphasis on improved “urgent” follow‐up with gastroenterology; improving this access is a focus of some quality improvement initiatives such as IBD Qorus 8 . Under such a model, corticosteroid use could be reviewed and modified in a timely manner, and escalation of steroid‐sparing therapy could be expedited.…”

Editorial: progress towards more comprehensively understanding the sources of corticosteroids for patients with inflammatory bowel disease—authors' reply

“…The need for this focus has also been recognised by the US IBD Qorus initiative. 6 It is vital that patients who require steroids get reviewed rapidly by the IBD service to allow for appropriate treatment escalation. The landscape of IBD treatment is rapidly changing and we cannot expect non-specialists to navigate this increasingly complex therapeutic field.…”

“…Often small changes can improve access significantly; for example, reserving a proportion of IBD clinic slots for last minute booking for patients with flares instead of routine follow‐up allows for more prompt management of flares without overall capacity increases in the service. The need for this focus has also been recognised by the US IBD Qorus initiative 6 . It is vital that patients who require steroids get reviewed rapidly by the IBD service to allow for appropriate treatment escalation.…”

Interactive Inflammatory Bowel Disease Biologics Decision Aid Does Not Improve Patient Outcomes Over Static Education: Results From a Randomized Trial

“…Study sites included member clinics within IBD Qorus (13,14); although the Cedars-Sinai IBD Center (Los Angeles, CA) is part of IBD Qorus, it was treated as a separate "site" for this study because we had direct access to patient lists for participating physicians. Starting on March 5, 2019, patients scheduled to be seen at Cedars-Sinai were sent an e-mail 1 week before their visit inviting them to participate in the study and to access the screening survey.…”