Quality improvement project helps identify IBD diagnosis delays
Time to patient presentation was the largest component of time to diagnosis of inflammatory bowel disease, according to research published in Alimentary Pharmacology & Therapeutics.
James R. Goodhand, of Exeter IBD and Pharmacogenetics Research Group in the United Kingdom, and colleagues wrote that a timely diagnosis in IBD is critical for management of the disease.
“Contemporary studies of the time to diagnosis of IBD from the UK, where healthcare is free at the point-of-access and general practitioners act as gatekeepers to secondary care services, are lacking,” they wrote. “Most patients who present to primary care with gastrointestinal symptoms will have a functional gut disorder and only a minority will have IBD. Distinguishing between irritable bowel syndrome and IBD, even in the presence of red-flag symptoms is difficult, and misdiagnosis is common.”
To determine factors associated with and the consequences of a prolonged diagnosis in IBD, researchers conducted a quality improvement study comprising 304 adults with a new IBD diagnosis made between January 2014 and December 2017. They assessed outcome measures associated with delayed time (defined as greater than upper quartile) to patient presentation, general practitioner referral and secondary care diagnosis.
Investigators also explored which factors were associated with a more complicated disease course in the year after diagnosis, using outcomes such as, hospitalization, surgery and biologic treatment.
Goodhand and colleagues found that the median time to diagnosis at each sub-interval were 2.1 months to patient presentation, 0.3 months for general practitioner referral and 1.1 months to secondary care diagnosis. Half of patients were diagnosed within 4 months, and 92% were diagnosed withing 2 years of onset of symptoms. Delay in diagnosis was longer in Crohn’s disease (7.6 months) than in ulcerative colitis (3.3 months).
Investigators found that patients with a delayed diagnosis were not more likely to have a more complicated disease course, but patients who had an emergent presentation were (P < .001).
“Time to patient presentation was the largest component of time to IBD diagnosis,” Goodhand and colleagues wrote. “Emergent presentation is common and, unlike a delayed time to diagnosis, is associated with a complicated disease course. Patients with suspected IBD should be triaged straight-to-test.”