Quality improvement collaborative improves outcomes in children with inflammatory bowel disease
The care of children with inflammatory bowel disease (IBD), Crohn's disease (CD), or ulcerative colitis (UC) can be complex. There is a lack of consensus on the best way to manage these patients. As a result, variations in care delivery exist in both diagnosis and treatment. However, a new study suggests that a quality improvement (QI) collaborative may improve outcomes for these chronic conditions. The QI system uses training, coaching, team building, and performance self-reporting to create new care approaches and then to test them.
A network of six care centers shared in the costs of creating the program's technical infrastructure and data sharing. Changes in care delivery were based on the Chronic Illness Care Model. The changes included a set of recommendations to standardize diagnosis, classify disease severity, and evaluate the patient's nutritional and growth status. As care processes improved, additional changes were implemented that centered on medications, managing nutrition and growth, and inducing and maintaining disease remission. A Model IBD Care Guideline was developed to help standardize therapy.
Testing the care changes and collecting monthly data on them revealed several positive outcomes. First, there was an increase in the proportion of medical visits with complete disease classification. Second, there was more frequent measurement of thiopurine methyltransferase (TPMT) levels before thiopurines were administered (drugs commonly used to treat these conditions). Patients were more likely to receive an initial thiopurine dose appropriate to their TPMT level. There was also an increase in the number of CD and UC patients who went into remission. Finally, the application of evidence-based changes resulted in an increase in the percentage of CD patients not taking corticosteroids. The study was supported in part by the Agency for Healthcare Research and Quality (HS16957).
See "Improved outcomes in a quality improvement collaborative for pediatric inflammatory bowel disease," by Wallace V. Crandall, MD, Peter A. Margolis, MD, PhD, Michael D. Kappelman, MD, MPH, and others in the April 2012 Pediatrics 129(4), pp. e1030-e1041.