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Dong M, Xiao Y, Shi C, Zeng W, Wu F, Li G. Which Contributes to Clinical Performance: Academic Output or Person–Environment Fit? Front Public Health 2022; 10:801917. [PMID: 35309226 PMCID: PMC8931592 DOI: 10.3389/fpubh.2022.801917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background The measures put in place by health authorities to ensure the professionalism of doctors are important. Hospitals in China have included academic outputs in the promotion criteria to incentive medical clinicians to engage in scientific research so that to improve job performance (JP). However, such practice disproportionally focuses on academic outputs but ignores the force of needs fulfilled brought by intrinsic incentive. This study aims to discuss the realistic problem regarding the promotion mechanism and the potential drivers to clinical JP. Methods This study was based on multi-source data collection on clinical performance from electric medical record (EMR), person-environment (P–E) fit from the survey, and academic output from personnel files of ward clinicians (n = 244) of general public hospitals who sought for career progression in Shanghai in 2020. Independent-Sample t-test and chi-square test were used for comparison of two sample means or constituent ratio between promoted and not promoted clinicians. Linear multilevel regression was conducted to examine the relationship between clinical performance and academic outputs and P–E fit. Results Clinicians who were promoted were more productive in producing academic outputs than those who were not (t = −5.075, p < 0.001). However, there was no difference in clinical performance between the two groups (t = −1.728 to 0.167, p > 0.05). The regression showed that academic outputs were not related to clinical performance, while higher P–E fit was associated with the improvement of various clinical performances. Conclusion This study shows that P–E fit plays a more important role in facilitating clinical performance than academic performance and highlights the importance of intrinsic motivation of clinicians in achieving clinical performance.
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Affiliation(s)
- Minye Dong
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Health Technology Assessment, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Yuyin Xiao
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Health Technology Assessment, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Chenshu Shi
- Center for Health Technology Assessment, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Winking Entertainment Corporation, Shanghai, China
| | - Wu Zeng
- Department of International Health, Georgetown University, Washington, DC, United States
| | - Fan Wu
- Shanghai Medical College, Fudan University, Shanghai, China
- *Correspondence: Fan Wu
| | - Guohong Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Health Technology Assessment, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
- Guohong Li
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2
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Fiorino G, Danese S. The new frontier: Certifying quality standards in the inflammatory bowel disease care. United European Gastroenterol J 2021; 9:745-747. [PMID: 34245668 DOI: 10.1002/ueg2.12122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Gionata Fiorino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IBD Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IBD Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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3
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Choe MY, Wright R, Parian A. Follow-up Care in Inflammatory Bowel Disease: An Integrative Review. Gastroenterol Nurs 2021; 44:E48-R58. [PMID: 34037572 DOI: 10.1097/sga.0000000000000570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/14/2020] [Indexed: 01/12/2023] Open
Abstract
Inflammatory bowel disease is characterized by chronic inflammation of the gastrointestinal tract and is associated with high risks for complications, surgeries, and frequent hospitalizations. Approximately one in four inflammatory bowel disease patients are readmitted to the hospital within 90 days of discharge in the United States. Although existing literature showed a timely clinic appointment with gastroenterologists is a protective factor for disease flare-ups and hospitalizations, the follow-up appointments were found to be either lacking or significantly delayed. Further, evidence-based guidelines in timely inflammatory bowel disease care are lacking. Thus, this integrative review examined current literature to identify effective strategies for achieving timely clinic appointments with gastroenterologists in inflammatory bowel disease. A comprehensive search of three electronic databases (PubMed, Embase, and Cumulative Index of Nursing and Allied Health Literature [CINAHL] Plus) was conducted from January 2009 to September 2019 using the key terms: inflammatory bowel disease, ulcerative colitis, Crohn's disease, appointments, and time to appointment. Nine articles met the inclusion criteria. The main interventions for timely inflammatory bowel disease care included (i) clinic-wide scheduling protocols, (ii) a dedicated healthcare team, (iii) efficient referral process, (iv) appointment management based on disease acuity and severity, and (v) addressing shortage of inflammatory bowel disease clinicians. Further research is needed to quantify the magnitude of timely inflammatory bowel disease care interventions with controls and evaluate the efficacy with a head-to-head trial. Through timely referrals, evaluations, and treatments, these quality improvement endeavors will ultimately improve quality of care and contribute to reduction in preventable hospitalizations and associated healthcare costs from delayed outpatient inflammatory bowel disease care.
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Affiliation(s)
- Monica Y Choe
- Monica Y. Choe, DNP, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Rebecca Wright, PhD, BSc (Hons), RN, is Assistant Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Assistant Professor of Medicine, Associate Clinical Director of Gastroenterology & Hepatology, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rebecca Wright
- Monica Y. Choe, DNP, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Rebecca Wright, PhD, BSc (Hons), RN, is Assistant Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Assistant Professor of Medicine, Associate Clinical Director of Gastroenterology & Hepatology, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Alyssa Parian
- Monica Y. Choe, DNP, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Rebecca Wright, PhD, BSc (Hons), RN, is Assistant Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Assistant Professor of Medicine, Associate Clinical Director of Gastroenterology & Hepatology, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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4
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Prior SJ, Mather C, Miller A, Campbell S. An academic perspective of participation in healthcare redesign. Health Res Policy Syst 2019; 17:87. [PMID: 31747900 PMCID: PMC6868692 DOI: 10.1186/s12961-019-0486-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
Healthcare redesign, based on building collaborative capacity between academic and clinical partners, should create a method to facilitate flow between the key elements of health service improvement. However, utilising the skills and resources of an organisation outside of the health facility may not always have the desired effect. Accountability and mutually respectful relationships are fundamental for collaborative, sustainable and successful completion of clinical research projects. This paper provides an academic perspective of both the benefits of academic involvement in facilitating healthcare redesign processes as well as the potential pitfalls of involving external partner institutions in internal healthcare redesign projects.
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Affiliation(s)
- Sarah Jane Prior
- School of Medicine, College of Health and Medicine, University of Tasmania,, Cradle Coast Campus, Mooreville Road, Burnie, Tasmania, 7320, Australia.
| | - Carey Mather
- School of Nursing, College of Health and Medicine, University of Tasmania,, Newnham Campus, Launceston, Tasmania, 7250, Australia
| | - Andrea Miller
- School of Nursing, College of Health and Medicine, University of Tasmania,, Newnham Campus, Launceston, Tasmania, 7250, Australia
| | - Steven Campbell
- School of Nursing, College of Health and Medicine, University of Tasmania,, Newnham Campus, Launceston, Tasmania, 7250, Australia
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5
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Ahmed Z, Sarvepalli S, Garber A, Regueiro M, Rizk MK. Value-Based Health Care in Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:958-968. [PMID: 30418558 DOI: 10.1093/ibd/izy340] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory disease associated with significant resource utilization and health care burden. It is emerging as a global disease affecting an increasing proportion of the population. Along with evolving epidemiological trends, the paradigm of managing IBD has also changed. With a burgeoning repertoire of therapeutic options, improved use of health informatics, and emphasis on health care value, the treatment paradigm for IBD has experienced seismic shifts. In this review, we focused on value-based health care (VBHC)-a health care model that emphasizes monitoring outcomes to emphasize patient-centered, cost-effective IBD patient care. Several quality initiatives have been developed worldwide, and successful models of care were created for proper implementation of these initiatives. Although there are significant challenges to scale these models to a national level, it is still possible to successfully implement VBHC models within health systems to improve the quality of care provided to patients with IBD.
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Affiliation(s)
- Zunirah Ahmed
- Department of Internal Medicine, University of Alabama, Montgomery, Alabama
| | | | - Ari Garber
- Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
| | - Miguel Regueiro
- Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
| | - Maged K Rizk
- Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
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6
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Jackson BD, De Cruz P. Quality of Care in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:479-489. [PMID: 30169698 DOI: 10.1093/ibd/izy276] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Indexed: 12/15/2022]
Abstract
The rising burden of inflammatory bowel disease (IBD) has the potential to have a negative impact on the quality of care delivered to patients with IBD. Quality of care has been described by the World Health Organization as "the extent to which health care services provided to individuals and patient populations improve desired health outcomes." Variation in care has been identified as a key barrier to achieving quality of care in IBD. Assessment of quality of care attempts to minimize variation in care. Quality indicators have been developed in IBD as a minimum standard of care according to evidence-based guidelines. Models of care to achieve and maintain quality include integrated care, participatory care, and value-based health care. In this review, we outline current approaches to the assessment of quality of care in IBD and explore models of care currently being used to achieve and maintain quality.
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Affiliation(s)
- Belinda D Jackson
- Department of Gastroenterology, The Austin Hospital, Melbourne, Australia.,Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, Australia
| | - Peter De Cruz
- Department of Gastroenterology, The Austin Hospital, Melbourne, Australia.,Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, Australia
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7
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Bitton A, Vutcovici M, Lytvyak E, Kachan N, Bressler B, Jones J, Lakatos PL, Sewitch M, El-Matary W, Melmed G, Nguyen G. Selection of Quality Indicators in IBD: Integrating Physician and Patient Perspectives. Inflamm Bowel Dis 2019; 25:403-409. [PMID: 30169582 DOI: 10.1093/ibd/izy259] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Variation in clinical practice exists in many aspects of inflammatory bowel disease (IBD) care. Our aim was to develop a comprehensive set of quality indicators (QIs) to be measured in view of improving the quality of IBD care provided in clinical practice. This initiative was part of a global Canadian quality initiative PACE (Promoting Access and Care through Centres of Excellence). METHODS A modified RAND appropriateness method was used to identify and rate structure, process, outcome, and patient-derived QIs of IBD care. The process included a comprehensive literature search yielding a broad list of QIs, the online selection of QIs by a core expert panel, the selection of patient-derived QIs from 4 patient focus groups, and the subsequent selection of QIs by a multidisciplinary panel, followed by a moderated in-person multidisciplinary meeting during which each indicator was rated for importance and feasibility of measurement. Predetermined cutoffs for mean score and degree of disagreement were used to select the final list of QIs. RESULTS Forty-five QIs, including 6 that were patient-derived, were selected. Nine structure QIs addressed aspects related to the services and specialist care offered at an IBD unit or clinic. Thirty process indicators included administrative and workflow processes, features related to IBD therapy, surveillance, vaccination, and risk management. Six outcome QIs included measures of healthcare utilization, steroid use, and patient satisfaction. CONCLUSIONS Forty-five QIs including patient-derived indicators were selected through an iterative process. These indicators can be used to measure and improve the quality of care provided to IBD patients. 10.1093/ibd/izy259_video1izy259.video15828250213001.
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Affiliation(s)
- Alain Bitton
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Maria Vutcovici
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ellina Lytvyak
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Brian Bressler
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Jones
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Maida Sewitch
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Wael El-Matary
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Gil Melmed
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Geoffrey Nguyen
- Mount Sinai Hospital, Center for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Canada
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8
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Fiorino G, Allocca M, Chaparro M, Coenen S, Fidalgo C, Younge L, Gisbert JP. 'Quality of Care' Standards in Inflammatory Bowel Disease: A Systematic Review. J Crohns Colitis 2019; 13:127-137. [PMID: 30423033 DOI: 10.1093/ecco-jcc/jjy140] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inflammatory bowel disease [IBD] includes chronic, disabling and progressive conditions that need a complex approach and management. Although several attempts have been made to standardize the care of IBD patients, no clear definitions of a global 'standard of care' are currently available. METHODS We performed a systematic review of the available literature, searching for all relevant data concerning three main domains of standards of quality of care in IBD patients: structure, process and outcomes. From the literature search, 2394 abstracts were retrieved, and 62 relevant papers were included in the final review. RESULTS Standards of quality of care in IBD include several aspects that can be summarized in three identified domains: structure, process and outcomes. The suggested structure of an IBD Unit includes a multi-disciplinary approach, effective referral processes, improved access using helplines, and departmental guidelines/pathways with identification of measurable quality indicators. Coordinated care models which incorporate a multi-disciplinary approach, structured clinical pathways or processes for the diagnosis, monitoring and treatment of IBD, fast-track recovery from IBD surgery, designated IBD clinics, virtual clinics and telemanagement are currently considered the main standards for process, although supporting data are limited. Several consensus statements on outcomes and quality indicators have been reported, focusing on outcomes in symptoms, function and quality of life restoration, survival and disease control, in addition to effective healthcare utilization. CONCLUSIONS The results of this systematic review can provide the basis for general recommendations for standards of quality of care in IBD.
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Affiliation(s)
- Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Mariangela Allocca
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Maria Chaparro
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Sofie Coenen
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Catarina Fidalgo
- Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal
| | - Lisa Younge
- Barts Health - Royal London Hospital, London, UK
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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9
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Gonczi L, Kurti Z, Golovics PA, Lovasz BD, Menyhart O, Seres A, Sumegi LD, Gal A, Ilias A, Janos P, Gecse KB, Bessisow T, Afif W, Bitton A, Vegh Z, Lakatos PL. Quality of care indicators in inflammatory bowel disease in a tertiary referral center with open access and objective assessment policies. Dig Liver Dis 2018; 50:37-41. [PMID: 29107471 DOI: 10.1016/j.dld.2017.09.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the management of inflammatory bowel diseases, there is considerable variation in quality of care. AIMS The aim of this study was to evaluate structural, access/process components and outcome quality indicators in our tertiary referral IBD center. METHODS In the first phase, structural/process components were assessed, followed by the second phase of formal evaluation of access and management on a set of consecutive IBD patients with and without active disease (248CD/125UC patients, median age 35/39 years). RESULTS Structural/process components of our IBD center met the international recommendations. At or around the time of diagnosis usual procedures were full colonoscopy in all patients, with ileocolonoscopy/gastroscopy/CT/MRI in 81.8/45.5/66.1/49.6% of CD patients. A total of 86.7% of CD patients had any follow-up imaging evaluation or endoscopy. The median waiting time for non-emergency endoscopy/CT/MRI was 16/14/22 days. During the observational period patients with flares (CD/UC:50.6/54.6%) were seen by specialist at the IBD clinic within a median of 1day with same day laboratory assessment, abdominal US, CT scan/surgical consult and change in therapy if needed. Surgery and hospitalization rates were 20.1/1.4% and 17.3/3.2% of CD/UC patients. CONCLUSION Our results highlight that structural components and processes applied in our center are in line with international recommendations, including an open clinic concept and fast track access to specialist consultation, endoscopy and imaging.
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Affiliation(s)
- Lorant Gonczi
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kurti
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Barbara Dorottya Lovasz
- First Department of Medicine, Semmelweis University, Budapest, Hungary; Faculty of Health Sciences, Department of Clinical Studies, Semmelweis University, Budapest, Hungary
| | - Orsolya Menyhart
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Anna Seres
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Liza Dalma Sumegi
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Alexander Gal
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Akos Ilias
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Papp Janos
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Talat Bessisow
- Division of Gastroenterology, McGill University, MUHC, Montreal General Hospital, Montreal, QC, Canada
| | - Waqqas Afif
- Division of Gastroenterology, McGill University, MUHC, Montreal General Hospital, Montreal, QC, Canada
| | - Alain Bitton
- Division of Gastroenterology, McGill University, MUHC, Montreal General Hospital, Montreal, QC, Canada
| | - Zsuzsanna Vegh
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter Laszlo Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary; Division of Gastroenterology, McGill University, MUHC, Montreal General Hospital, Montreal, QC, Canada.
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10
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Daperno M, Bortoli A, Kohn A, Politi P, Marconi S, Ardizzone S, Cortelezzi CC, Grasso G, Ferraris L, Milla M, Spina L, Guidi L, Losco A, Inserra G, Sablich R, Morganti D, Bodini G, Comberlato M. Patient and physician views on the quality of care for inflammatory bowel disease after one-year follow-up: Results from SOLUTION-2, a prospective IG-IBD study. Dig Liver Dis 2017; 49:997-1002. [PMID: 28595949 DOI: 10.1016/j.dld.2017.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Perception of quality of care is important in the management of patients with chronic diseases, particularly inflammatory bowel disease. AIMS AND METHODS This longitudinal study aimed to investigate variations of the Quality of Care through the Patients' Eyes (QUOTE-IBD) questionnaire scores one year after the basal evaluation in the Studio Osservazionale quaLità cUre malatTIe crOniche intestiNali (SOLUTION-1) study. RESULTS Of the cohort of 992 patients, 936 were evaluable. The QUOTE-IBD score overcame satisfactory levels of more than the 80%, overall and in all subdomains except for the "Continuity of Care" sub-dimension (mean, 8.3; standard deviation, 1.49), scored satisfactory only by 34% of the patients. No significant changes in satisfaction were recorded overall, or considering patients subgroups. Significant differences were found at the end of the follow-up between physicians' and patients' perceptions of quality of care, with the former over-rating their performance in "Continuity of Cares" and under-rating "Costs", "Competence", and "Accessibility" sub-domains of the score (p<0.05 for all). CONCLUSION Perceived quality of care in a large cohort of Italian patients with inflammatory bowel disease remains unchanged after one-year follow-up and was not significantly affected by disease activity or therapeutic interventions. Differences between physicians' and patients' perceptions of quality of care should be taken into account.
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Affiliation(s)
- Marco Daperno
- Department of Gastroenterology, Mauriziano Hospital, Turin, Italy.
| | | | - Anna Kohn
- Department of Gastroenterology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Stefano Marconi
- Medical Department, Chiesi Italian Pharmaceutical Group, Parma, Italy
| | - Sandro Ardizzone
- Gastroenterology Unit, L. Sacco University Hospital, Milan, ASST Fatebenefratelli Sacco, Italy
| | | | - Gianalberto Grasso
- Gastroenterology Unit, Carlo Ondoli Hospital, Angera, ASST Valle Olona, Italy
| | - Luca Ferraris
- Gastroenterology Unit, Gallarate Hospital, ASST Valleolona, Italy
| | - Monica Milla
- Gastroenterology Unit, University Hospital Careggi, Florence, Italy
| | - Luisa Spina
- Gastroenterology Department, IRCCS Policlinico San Donato Milanese, Italy
| | - Luisa Guidi
- Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli, Presidio Columbus, Rome, Italy
| | - Alessandra Losco
- Hepatology and Gastroenterology Department, San Paolo Hospital, Milan, ASST Santi Paolo e Carlo, Italy; Division of Internal Medicine, Liver and Gastroenterology Unit, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Gaetano Inserra
- Internal Medicine Unit, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico", Catania, Italy
| | - Renato Sablich
- Gastroenterology Unit, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Daniela Morganti
- Gastroenterology Unit, Garbagnate Milanese Hospital, ASST Rhodense, Italy
| | | | - Michele Comberlato
- Gastroenterology and Digestive Endoscopy Department, Bolzano Central Hospital, Italy
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11
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Seo GS. [Quality of care in inflammatory bowel disease]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 65:139-44. [PMID: 25797376 DOI: 10.4166/kjg.2015.65.3.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Since inflammatory bowel disease (IBD) is a chronic and relapsing disorder, maintaining high quality of care plays an important role in the management of patients with IBD. To develop process-based quality indicator set to improve quality of care, the indicator should be based directly on evidence and consensus. Initially, ImproveCareNow group demonstrated quality improvement by learning how to apply quality improvement methods to improve the care of pediatric patients with IBD. The American Gastroenterological Association has developed adult IBD physician performance measures set and Crohn's and Colitis Foundation of America (CCFA) has developed a set of ten most highly rated process and outcome measures. Recently, The Emerging Practice in IBD Collaborative (EPIC) group generated defining quality indicators for best-practice management of IBD in Canada. Quality of Care through the Patient's Eyes (QUOTE-IBD) was developed as a questionnaire to measure quality of care through the eyes of patients with IBD, and it is widely used in European countries. The current concept of quality of care as well as quality indicator will be discussed in this article.
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Affiliation(s)
- Geom Seog Seo
- Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Korea
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12
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Bortoli A, Daperno M, Kohn A, Politi P, Marconi S, Monterubbianesi R, Castiglione F, Corbellini A, Merli M, Casella G, D'Incà R, Orlando A, Bossa F, Doldo P, Lecis P, Valpiani D, Danese S, Comberlato M. Patient and physician views on the quality of care in inflammatory bowel disease: results from SOLUTION-1, a prospective IG-IBD study. J Crohns Colitis 2014; 8:1642-52. [PMID: 25113898 DOI: 10.1016/j.crohns.2014.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/29/2014] [Accepted: 07/13/2014] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Remarkable differences in quality of care (QoC) might be observed in different countries, affecting quality of life of inflammatory bowel disease (IBD) patients. The aim of this study was to assess patient and physician perceptions of the QoC in Italy. METHODS A multicentre observational study on the quality of care in IBD (SOLUTION-1) was conducted in 36 IG-IBD (Italian Group for Inflammatory Bowel Disease) centres in Italy. The QUOTE-IBD (Quality of Care Through the Patient's Eyes) questionnaire was administered to IBD patients and to the attending physicians. The Quality Impact (QI) score summarises the QUOTE-IBD questionnaire, and a QI >9 is considered satisfactory. RESULTS Nine-hundred-ninety-two patients and 75 physicians completed the QUOTE-IBD questionnaire. The patients scored the domains of competence (9.47 vs. 8.55) and costs (9.54 vs. 8.26) higher that the physicians, while information (9.31 vs. 9.43) and continuity of care (8.40 vs. 9.01) were scored lower. The QI score was rated worse by physicians with less experience (<12 years) with regard to competence (8.0 vs. 9.01), courtesy (8.12 vs. 10.0) and autonomy (8.97 vs. 10.0). Physicians considered the cost domain unsatisfactory. CONCLUSIONS Healthcare was rated as satisfactory overall for Italian patients and physicians. The physicians underestimate their competence and consider the cost of medical management unsatisfactory. The patients are more critical regarding the continuity of care and information. Country-specific data on QoC allow local governments to allocate resources more effectively.
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Affiliation(s)
- Aurora Bortoli
- Department of Gastroenterology and Digestive Endoscopy, A.O.G.Salvini, Rho Hospital, Italy.
| | - Marco Daperno
- Gastroenterology Unit, A.O. Ordine Mauriziano, Turin, Italy
| | - Anna Kohn
- Department of Gastroenterology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Stefano Marconi
- Medical Department, Chiesi Italian Pharmaceutical Group, Parma, Italy
| | | | | | - Ada Corbellini
- Department of Medicine, Vizzolo Predabissi Hospital, AO Melegnano,MI, Italy
| | - Manuela Merli
- II Department of Gastroenterology, "La Sapienza" University, Rome, Italy
| | | | - Renata D'Incà
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Italy
| | - Ambrogio Orlando
- Department of Medicine, Pneumology and Nutrition Clinic, "V. Cervello" Hospital, Ospedali Riuniti "Villa Sofia-Cervello" University of Palermo, Italy
| | - Fabrizio Bossa
- Gastroenterology Unit, CSS-IRCCS Hospital, San Giovanni Rotondo, Italy
| | - Patrizia Doldo
- Department of Gastroenterology and Digestive Endoscopy, University of Catanzaro, Italy
| | - Pierenrico Lecis
- Department of Gastroenterology and Digestive Endoscopy, San Martino Hospital, Belluno, Italy
| | - Daniela Valpiani
- Department of Gastroenterology and Digestive Endoscopy, Morgagni Hospital, Forlì, Italy
| | - Silvio Danese
- Gastroenterology Istituto Clinico Humanitas IRCCS, Rozzano,MI, Italy
| | - Michele Comberlato
- Gastroenterology and Digestive Endoscopy Departement, Bolzano Central Hospital, Italy
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Shah R, Hou JK. Approaches to improve quality of care in inflammatory bowel diseases. World J Gastroenterol 2014; 20:9281-9285. [PMID: 25071321 PMCID: PMC4110558 DOI: 10.3748/wjg.v20.i28.9281] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 04/23/2014] [Indexed: 02/06/2023] Open
Abstract
Studies across medical disciplines have shown gaps in the care recommended in evidence based guidelines and the care actually delivered. Quality improvement projects using systematic audit and feedback interventions such as quality measures, will become increasingly important tools to address these gaps in care. These gaps are also apparent in the care of patients with inflammatory bowel disease. Multiple organizations, including the American Gastroenterology Association and the Crohn’s and Colitis Foundation of America, have developed programs designed to implement quality measures to improve the care of inflammatory bowel disease (IBD) patients. Early results show promise of improving quality, but numerous barriers remain. Gastroenterologists need to be aware of these processes to provide the highest care possible to patients with IBD. We review the existing literature on approaches to quality improvement and their potential application and barriers when applied to IBD care.
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14
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Weizman AV, Nguyen GC. Interventions and targets aimed at improving quality in inflammatory bowel disease ambulatory care. World J Gastroenterol 2013; 19:6375-6382. [PMID: 24151356 PMCID: PMC3801308 DOI: 10.3748/wjg.v19.i38.6375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/15/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023] Open
Abstract
Over the past decade, there has been increasing focus on improving the quality of healthcare delivered to patients with chronic diseases, including inflammatory bowel disease. Inflammatory bowel disease is a complex, chronic condition with associated morbidity, health care costs, and reductions in quality of life. The condition is managed primarily in the outpatient setting. The delivery of high quality of care is suboptimal in several ambulatory inflammatory bowel disease domains including objective assessments of disease activity, the use of steroid-sparing agents, screening prior to anti-tumor necrosis factor therapy, and monitoring thiopurine therapy. This review outlines these gaps in performance and provides potential initiatives aimed at improvement including reimbursement programs, quality improvement frameworks, collaborative efforts in quality improvement, and the use of healthcare information technology.
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M'Koma AE. Inflammatory bowel disease: an expanding global health problem. CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2013; 6:33-47. [PMID: 24833941 PMCID: PMC4020403 DOI: 10.4137/cgast.s12731] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This review provides a summary of the global epidemiology of inflammatory bowel diseases (IBD). It is now clear that IBD is increasing worldwide and has become a global emergence disease. IBD, which includes Crohn’s disease (CD) and ulcerative colitis (UC), has been considered a problem in industrial-urbanized societies and attributed largely to a Westernized lifestyle and other associated environmental factors. Its incidence and prevalence in developing countries is steadily rising and has been attributed to the rapid modernization and Westernization of the population. There is a need to reconcile the most appropriate treatment for these patient populations from the perspectives of both disease presentation and cost. In the West, biological agents are the fastest-growing segment of the prescription drug market. These agents cost thousands of dollars per patient per year. The healthcare systems, and certainly the patients, in developing countries will struggle to afford such expensive treatments. The need for biological therapy will inevitably increase dramatically, and the pharmaceutical industry, healthcare providers, patient advocate groups, governments and non-governmental organizations should come to a consensus on how to handle this problem. The evidence that IBD is now affecting a much younger population presents an additional concern. Meta-analyses conducted in patients acquiring IBD at a young age also reveals a trend for their increased risk of developing colorectal cancer (CRC), since the cumulative incidence rates of CRC in IBD-patients diagnosed in childhood are higher than those observed in adults. In addition, IBD-associated CRC has a worse prognosis than sporadic CRC, even when the stage at diagnosis is taken into account. This is consistent with additional evidence that IBD negatively impacts CRC survival. A continuing increase in IBD incidence worldwide associated with childhood-onset of IBD coupled with the diseases’ longevity and an increase in oncologic transformation suggest a rising disease burden, morbidity, and healthcare costs. IBD and its associated neoplastic transformation appear inevitable, which may significantly impact pediatric gastroenterology and adult CRC care. Due to an infrastructure gap in terms of access to care between developed vs. developing nations and the uneven representation of IBD across socioeconomic strata, a plan is needed in the developing world regarding how to address this emerging problem.
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Affiliation(s)
- Amosy E M'Koma
- Laboratory of Inflammatory Bowel Disease Research, Department of Biochemistry and Cancer Biology, Meharry Medical College, Nashville TN. Departments of General Surgery, Colon and Rectal Surgery, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville TN
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