AUSTIN, Texas — A quality improvement program that helps facilities make changes in practice structure and share best practices helped improve outcomes among patients with inflammatory bowel disease, according to research presented at Crohn’s and Colitis Congress.
“Quality measures or indicators of care for IBD have been developed and published. However, there are multiple studies that have shown significant variation in the quality of IBD care suggesting that there may be significant room for improvement,” Gil Y. Melmed, MD, director of clinical IBD at Cedars-Sinai Medical Center, said in his presentation. “Our hypothesis was that a structured quality of care program can reduce variation and improve outcomes for patients with IBD.”
Researchers used the Breakthrough Series Collaborative approach — a program developed by the Institute for Healthcare Improvement — to implement the quality improvement plan through IBD Qorus, an intitative of the Crohns and Colitis Foundation. The15-month structured program included a key driver diagram to highlight the aims and goals and identify factors that can drive toward improvement in those areas, Melmed said. It also included a “change package,” designed by patients and providers to identify which changes to test in the real world that might help that improvement come along.
The model comes with three main questions:
- What are we trying to accomplish?
- How will we know that a change is an improvement?
- What change can we make that will result in improvement?
Researchers identified primary and secondary drivers of urgent care need for patients — like those at high risk for emergency department use — and developed 19 practice change ideas that could impact those factors. They tested and implemented various change ideas at clinical sites across the United States starting in January 2018 and conducted monthly webinars and three in-person meetings to share quality improvement methods and best practices.
Investigators collected data from 20,382 discrete visits at 26 participating practices.
Over the course of the 15-month program, Melmed and colleagues observed decreases in ED use (18% to 14%), hospitalization (14% to 11%), steroid use (14% to 10%) and narcotic use (8% to 4%).
Some of the successful change ideas included proactive maintenance of a “high risk” patient list, reserved outpatient visits for urgent needs, morning-after contact with patients who went to the ED, patient education about how and when to get help, and proactively scheduling earlier follow-up for high-risk patients.
“IBD outcomes can be improved using a structured quality improvement program,” Melmed said. “This program included small, iterative structure and process changes at the practice level. It required sharing of best practices across sites, and sites were given ongoing feedback so that we could all learn from each other in order to improve. Spread of successful interventions beyond IBD Qorus may facilitate broad improvement in IBD care and significant cost savings when applied to a large population.”
– by Alex Young
Melmed GY, et al. Abstract 28. Presented at: Crohn’s and Colitis Congress; Jan. 23-25, 2020; Austin, Texas.
Disclosure: Melmed reports consulting for Abbvie, Boehringer-Ingelheim, Celgene, Medtronic, Pfizer, Samsung Bioepis, Takeda, Techlab and receiving research support from Pfizer.