In the Journals

Quality improvements associated with reduced steroid excess in IBD

Assessing steroid use may provide an important method to measure quality improvements in the care of patients with inflammatory bowel disease, according to study results.

“Despite significant advances in both our understanding and treatment of IBD, corticosteroids remain a mainstay of treatment,” Christian P. Selinger, MD, MRCP, MSc, of the Leeds Gastroenterology Institute in the United Kingdom, and colleagues wrote. “Although an effective induction agent, steroids have no role as a maintenance agent and prolonged exposure can lead to a range of significant morbidities.”

After a previous study in 2015, several health centers in the U.K. took part in a quality improvement project aimed at reducing excess steroid use in patients with IBD. They provided new education programs for patients and physicians, opening telephone helplines and establishing rapid-access clinics all with the goal of reducing steroid use.

For this study, they compared steroid use among patients treated at these seven “intervention centers” with patients treated at 12 others that did not take part in the program.

In 2,385 total patients with IBD, researchers determined that 28% received steroids in the previous 12 months, and 14.8% had steroid excess or dependency. From 2015 to 2017, steroid use and excess use at the centers that took part in the quality improvement program declined (30% to 23.8%, P < .003 and 13.8% to 11.5%, P < .001, respectively). There was also a trend toward lower disease activity among patients treated at these centers.

Selinger and colleagues determined that maintenance with anti-TNF (OR = 0.61; 95% CI, 0.24–0.95), treatment in a center with a multidisciplinary care team (OR = 0.54; 95% CI, 0.2–0.86) and treatment at an intervention center (OR = 0.72; 95% CI, 0.46–0.97) were associated with reduced steroid excess in Crohn’s disease. Treatment at an intervention center was also linked with less steroid excess in ulcerative colitis (OR = 0.72; 95% CI, 0.45–0.95).

Selinger and colleagues wrote that following excess steroid use could provide a useful way to evaluate service and improve standard of care for patients with IBD.

“This advances the case for steroid excess as a potential key performance indicator of quality in IBD service, although in order for clinicians to benchmark their service and provide targets for improvements, any numerical goal attached to this key performance indicator would require consideration of case mix,” they wrote. “Further data, including from national and international contexts is needed.” by Alex Young

Disclosures: Selinger reports receiving unrestricted research grants from AbbVie and Warner Chilcott; consulting for AbbVie, Dr Falk, Janssen, Takeda and Warner Chilcott; and having speaking arrangements with AbbVie, Dr Falk, MSD and Takeda. Please see the full study for all other authors relevant financial disclosures.

Assessing steroid use may provide an important method to measure quality improvements in the care of patients with inflammatory bowel disease, according to study results.

“Despite significant advances in both our understanding and treatment of IBD, corticosteroids remain a mainstay of treatment,” Christian P. Selinger, MD, MRCP, MSc, of the Leeds Gastroenterology Institute in the United Kingdom, and colleagues wrote. “Although an effective induction agent, steroids have no role as a maintenance agent and prolonged exposure can lead to a range of significant morbidities.”

After a previous study in 2015, several health centers in the U.K. took part in a quality improvement project aimed at reducing excess steroid use in patients with IBD. They provided new education programs for patients and physicians, opening telephone helplines and establishing rapid-access clinics all with the goal of reducing steroid use.

For this study, they compared steroid use among patients treated at these seven “intervention centers” with patients treated at 12 others that did not take part in the program.

In 2,385 total patients with IBD, researchers determined that 28% received steroids in the previous 12 months, and 14.8% had steroid excess or dependency. From 2015 to 2017, steroid use and excess use at the centers that took part in the quality improvement program declined (30% to 23.8%, P < .003 and 13.8% to 11.5%, P < .001, respectively). There was also a trend toward lower disease activity among patients treated at these centers.

Selinger and colleagues determined that maintenance with anti-TNF (OR = 0.61; 95% CI, 0.24–0.95), treatment in a center with a multidisciplinary care team (OR = 0.54; 95% CI, 0.2–0.86) and treatment at an intervention center (OR = 0.72; 95% CI, 0.46–0.97) were associated with reduced steroid excess in Crohn’s disease. Treatment at an intervention center was also linked with less steroid excess in ulcerative colitis (OR = 0.72; 95% CI, 0.45–0.95).

Selinger and colleagues wrote that following excess steroid use could provide a useful way to evaluate service and improve standard of care for patients with IBD.

“This advances the case for steroid excess as a potential key performance indicator of quality in IBD service, although in order for clinicians to benchmark their service and provide targets for improvements, any numerical goal attached to this key performance indicator would require consideration of case mix,” they wrote. “Further data, including from national and international contexts is needed.” by Alex Young

Disclosures: Selinger reports receiving unrestricted research grants from AbbVie and Warner Chilcott; consulting for AbbVie, Dr Falk, Janssen, Takeda and Warner Chilcott; and having speaking arrangements with AbbVie, Dr Falk, MSD and Takeda. Please see the full study for all other authors relevant financial disclosures.