1
|
Karlovich N, McConnell R, Velayos F, Mahadevan U, Lewin S. Opioid Use and Outcomes in Patients Hospitalized With Acute Severe Ulcerative Colitis. Inflamm Bowel Dis 2024:izae216. [PMID: 39295282 DOI: 10.1093/ibd/izae216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Indexed: 09/21/2024]
Abstract
BACKGROUND Opioid use has not been shown to improve hospitalized inflammatory bowel disease patient pain scores and may prolong the length of stay (LOS). Additional clinical implications of opioid use, particularly high amounts, in the hospital setting have not yet been explored. We sought to determine how high opioid use impacts clinical outcomes in acute severe ulcerative colitis (ASUC). METHODS In this single-center study, we identified all patients hospitalized with ASUC who received intravenous corticosteroids from July 1, 2014 to December 31, 2021. Clinical outcomes including opioid exposure, cumulative intravenous corticosteroid dose, biologic rescue therapy initiation date, colectomy rate, opioid prescription at discharge, LOS, and hospitalization cost were collected. High opioid use was defined as ≥40 oral morphine equivalents (OMEs) per day. A univariable logistic regression was performed to evaluate the association of high opioid use with ASUC outcomes. RESULTS 185 eligible hospitalizations for ASUC were evaluated. 75 patients (41%) received opioids during hospitalization, and 20 patients (11%) received ≥40 OMEs/day. High opioid use was associated with a median 3-day delay in biologic rescue therapy initiation when compared with low/no opioid use (P = .02). 70% of patients with high opioid use received an opioid prescription at discharge compared with 10% of those with low/no use (P < .001). Opioid use was not associated with LOS, duration of corticosteroid therapy, colectomy rate, or hospitalization cost. CONCLUSIONS Among ASUC hospitalizations, high opioid use was associated with delayed biologic rescue therapy initiation and higher rates of opioid prescriptions at discharge.
Collapse
Affiliation(s)
- Norah Karlovich
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ryan McConnell
- Department of Gastroenterology, Palo Alto Medical Foundation, Palo Alto, CA, USA
| | - Fernando Velayos
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Uma Mahadevan
- Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Sara Lewin
- Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
2
|
Fierens L, Bossuyt P, Baert F, Baert D, Weltens C, Lavaerts M, Vanhaecht K, Rademakers FE, Ferrante M. Development of a set of measurable outcome indicators for Flemish patients with inflammatory bowel disease. Eur J Gastroenterol Hepatol 2024; 36:1075-1086. [PMID: 38916231 DOI: 10.1097/meg.0000000000002804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
OBJECTIVE Uniform and standardised quality measurement allows care assessment and improvement. Following a pragmatic consensus method we aimed to agree on a selection of measurable quality indicators that can be used to assess, benchmark and gradually improve inflammatory bowel disease (IBD) care in Flanders. METHODS Of 49 structures, 135 processes and 37 outcome indicators identified through literature, 58 were preselected and reformulated into measurable outcome indicators by four IBD physicians. A larger expert group scored the 58 indicators on a 10-point importance scale twice, endorsed by patient and expert perspectives in between rounds. Additional items could be suggested. A final selection and subset of indicators with room for improvement were agreed upon during a consensus meeting. RESULTS Fifty indicators received an importance score of 7 or higher by ≥80% of the participants (seven IBD nurses, one abdominal surgeon, one chief medical officer and 31 IBD physicians including two paediatricians). Eight indicators scored highly important by 60-80%, two indicators reintroduced by patients and one newly suggested, were discussed during the consensus meeting. Among 26 participants, eight indicators were agreed to be added to the final selection. Of the 58 selected items, 19 were retained in the improvement subset, related to patient-reported outcomes, use of hospital services and survival, patient characteristics, monitoring of disease activity and remission, endoscopy guidelines, infection prevention, steroid and other medication use. CONCLUSION Fifty-eight indicators were selected to assess IBD care in Flanders and a subset of 19 for use in clinical practice to steer quality improvement initiatives.
Collapse
Affiliation(s)
- Liselotte Fierens
- Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven
| | - Peter Bossuyt
- Imelda GI Clinical Research Centre, Imelda General Hospital, Bonheiden
| | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare
| | - Didier Baert
- Department of Gastroenterology, AZ Maria Middelares, Gent
| | | | | | - Kris Vanhaecht
- Department of Public Health and Primary Care, KU Leuven
- Department of Quality, University Hospitals Leuven
| | | | - Marc Ferrante
- Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
3
|
Sivanathan V, Basnayake C, Connell W, Wright E, Ding JN, Niewadomski O, Stanley A, Wilson-O'Brien A, Fry S, Samyue T, Lust M, Flanagan E, Thompson AJV, Kamm MA. Clinical outcomes amongst elderly patients with inflammatory bowel disease. Intern Med J 2023; 53:1866-1874. [PMID: 36112394 DOI: 10.1111/imj.15928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS AND AIMS Inflammatory bowel disease (IBD) affects a growing cohort of elderly patients. Our aim was to compare the quality of care received by elderly patients with IBD with a nonelderly adult IBD population using clinical markers including steroid-free clinical remission. METHOD Retrospective audit of all consecutive patients attending a specialist IBD centre over a 1-year period aged >60 (elderly cohort [EC]) and 50 consecutive patients aged 30-45 years (control cohort [CC]). A follow-up survey was completed assessing current symptoms and perceptions of care. RESULTS One hundred thirty-nine patients were evaluated (89 EC, 50 CC). Steroid-free clinical remission was observed less commonly in the EC (58, 64%) compared with the CC (40, 80%) (P < 0.05). Biologics such as infliximab (15% EC vs 36% CC; P < 0.01) and adalimumab (14% EC vs 30% CC; P = 0.02) were used less frequently in the EC, whilst vedolizumab (6% EC vs 6% CC; P = 1) and ustekinumab (3% EC vs 2% CC; P = 1) were used at a similar frequency. Patients in the EC were less likely to have specialist IBD nursing contact (P < 0.01), smoking screening (P < 0.011) or influenza vaccinations (P < 0.006). IBD nurse contact was associated with significantly greater provision of the preventative care measures. CONCLUSION Elderly patients with IBD were less likely to experience steroid-free clinical remission or be prescribed biologics. Elderly patients were less likely to receive education with respect to preventative medicine. The models of care for the elderly need re-evaluation and greater incorporation with the multidisciplinary IBD team.
Collapse
Affiliation(s)
| | - Chamara Basnayake
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - William Connell
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Emily Wright
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - John Nik Ding
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Ola Niewadomski
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Annalise Stanley
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Amy Wilson-O'Brien
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Stephanie Fry
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Tamie Samyue
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Mark Lust
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Emma Flanagan
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alexander J V Thompson
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Michael A Kamm
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Bohra A, Vasudevan A, Kutaiba N, Van Langenberg DR. Challenges and Strategies to Optimising the Quality of Small Bowel Magnetic Resonance Imaging in Crohn’s Disease. Diagnostics (Basel) 2022; 12:diagnostics12102533. [PMID: 36292222 PMCID: PMC9600769 DOI: 10.3390/diagnostics12102533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022] Open
Abstract
Magnetic resonance enterography (MRE) is one of the most highly utilised tools in the assessment of patients with small bowel Crohn’s disease (CD). As a non-invasive modality, it has both patient and procedure-related advantages over ileocolonoscopy which is the current gold standard for Crohn’s disease activity assessment. MRE relies upon high-quality images to ensure accurate disease activity assessment; however, few studies have explored the impact of image quality on the accuracy of small bowel CD activity assessment. Bowel distension and motion artifacts are two key imaging parameters that impact the quality of images obtained through MRE. Multiple strategies have been employed to both minimise the effects of motion artifacts and improve bowel distension. This review discusses the definitions of bowel distension and motion artifacts within the literature with a particular focus on current strategies to improve bowel distension and limit motion artifacts in MRE.
Collapse
Affiliation(s)
- Anuj Bohra
- Department of Gastroenterology, Eastern Health, Box Hill 3128, Australia
- Correspondence:
| | - Abhinav Vasudevan
- Department of Gastroenterology, Eastern Health, Box Hill 3128, Australia
| | - Numan Kutaiba
- Department of Radiology, Eastern Health, Box Hill 3128, Australia
| | | |
Collapse
|
5
|
Adler J, Eder SJ, Gebremariam A, Moran CJ, Bass LM, Moses J, Lewis JD, Singer AAM, Morhardt TL, Picoraro JA, Cardenas V, Zacur GM, Colletti RB. Quantification of Mucosal Activity from Colonoscopy Reports via the Simplified Endoscopic Mucosal Assessment for Crohn's Disease. Inflamm Bowel Dis 2022; 28:1537-1542. [PMID: 34964861 DOI: 10.1093/ibd/izab315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Endoscopic mucosal healing is the gold standard for evaluating Crohn's disease (CD) treatment efficacy. Standard endoscopic indices are not routinely used in clinical practice, limiting the quality of retrospective research. A method for retrospectively quantifying mucosal activity from documentation is needed. We evaluated the simplified endoscopic mucosal assessment for CD (SEMA-CD) to determine if it can accurately quantify mucosal severity recorded in colonoscopy reports. METHODS Pediatric patients with CD underwent colonoscopy that was video recorded and evaluated via Simple Endoscopic Score for CD (SES-CD) and SEMA-CD by central readers. Corresponding colonoscopy reports were de-identified. Central readers blinded to clinical history and video scoring were randomly assigned colonoscopy reports with and without images. The SEMA-CD was scored for each report. Correlation with video SES-CD and SEMA-CD were assessed with Spearman rho, inter-rater, and intrarater reliability with kappa statistics. RESULTS Fifty-seven colonoscopy reports were read a total of 347 times. The simplified endoscopic mucosal assessment for CD without images correlated with both SES-CD and SEMA-CD from videos (rho = 0.82, P < .0001 for each). The addition of images provided similar correlation. Inter-rater and intrarater reliability were 0.93 and 0.92, respectively. CONCLUSIONS The SEMA-CD applied to retrospective evaluation of colonoscopy reports accurately and reproducibly correlates with SES-CD and SEMA-CD of colonoscopy videos. The SEMA-CD for evaluating colonoscopy reports will enable quantifying mucosal healing in retrospective research. Having objective outcome data will enable higher-quality research to be conducted across multicenter collaboratives and in clinical registries. External validation is needed.
Collapse
Affiliation(s)
- Jeremy Adler
- C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Susan B. Meister Child Health Evaluation and Research Center, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sally J Eder
- Susan B. Meister Child Health Evaluation and Research Center, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Acham Gebremariam
- Susan B. Meister Child Health Evaluation and Research Center, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Lee M Bass
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonathan Moses
- UH/Rainbow Babies & Children's Hospital, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland, OH, USA
| | | | - Andrew A M Singer
- C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tina L Morhardt
- Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, USA
| | | | - Vanessa Cardenas
- Children's Hospital of Alabama, University of Alabama Birmingham, Birmingham, AL, USA
| | - George M Zacur
- C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | | |
Collapse
|
6
|
Fudman DI, Perez-Reyes AE, Niccum BA, Melmed GY, Khalili H. Interventions to Decrease Unplanned Healthcare Utilization and Improve Quality of Care in Adults With Inflammatory Bowel Disease: A Systematic Review. Clin Gastroenterol Hepatol 2022; 20:1947-1970.e7. [PMID: 34481951 DOI: 10.1016/j.cgh.2021.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Inflammatory bowel disease (IBD) care and outcomes exhibit substantial variability, suggesting quality gaps. We aimed to identify interventions to narrow these gaps. METHODS We performed a systematic review of Medline, Embase, and Web of Science through May 2021 to find manuscripts and abstracts reporting quality improvement (QI) interventions in IBD. We included studies with interventions that addressed acute care utilization, vaccination, or Crohn's and Colitis Foundation quality indicators for care processes, including pre-therapy testing, tobacco cessation, colorectal cancer surveillance, Clostridium difficile infection screening in flares, sigmoidoscopy in patients hospitalized with ulcerative colitis, and use of steroid-sparing therapy. The primary objective was to identify successful QI interventions. Risk of bias assessment was conducted using the Joanna Briggs Institute critical appraisal checklist. RESULTS Twenty-three manuscripts and 23 meeting abstracts met inclusion criteria. Influenza and pneumococcal vaccination were the most studied indicators (24 references), followed by emergency room and/or hospital utilization, tobacco cessation, and pre-therapy testing (17, 11, and 10 references, respectively). Electronic medical record-based interventions were the most frequent, whereas other initiatives used strategies that included changes to care structure or delivery, vaccination protocols, or physician and patient education. Successful interventions matched the complexity of the metric to the intervention including making changes to care structure or delivery, empowered non-physician staff, and used electronic medical record changes to prompt clinicians. CONCLUSIONS The quality of IBD care can be improved with diverse interventions that range from simple to complex. However, these interventions are not universally successful. Clinicians should emulate successful interventions and design new initiatives to narrow gaps in care quality.
Collapse
Affiliation(s)
- David I Fudman
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Andrea Escala Perez-Reyes
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Blake A Niccum
- Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Gil Y Melmed
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, New York, New York
| | - Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| |
Collapse
|
7
|
Jun S, Jie L, Ren M, Zhihua R. Secondary Indicators for an Evaluation and Guidance System for Quality of Care in Inflammatory Bowel Disease Centers: A Critical Review of the Inflammatory Bowel Disease Quality of Care Center. Inflamm Bowel Dis 2022; 28:S3-S8. [PMID: 35247049 DOI: 10.1093/ibd/izac009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Indexed: 12/13/2022]
Abstract
The number of patients with inflammatory bowel disease (IBD) has increased remarkably in recent years. However, the level of health care for IBD patients varies greatly among regions of China. Standardization of health care for IBD patients is essential to improve quality of care (QoC). The mission of the IBD Quality Care Evaluation Center (IBDQCC) is to establish indicators for QoC. Since 2017, the IBDQCC has developed structure, process, and outcome indicators with the steering committee of IBD specialists and methodologists; 28 core and 13 secondary IBD QoC indicators were selected using a Delphi method. Applications for certification of IBD quality care units were made voluntarily and preliminarily screened through the IBDQCC committee. Regional units had to meet all core indicators, and units of excellence were required to meet all core indicators together with an additional 50% of secondary indicators. As of 2019 and 2020, 69 IBD units (all from tertiary referral hospitals) have been certified as regional IBD units in China. The certification of excellence of the IBD units is currently undergoing auditing. The awareness of and appreciation for QoC in IBD is increasing in China, especially through the quality control evaluation program initiated by the IBDQCC, with a higher number of IBD units applying for the next round of certification. Although secondary indicators seem to play relatively minor roles in QoC, they suggest additional requirements for high-level centers.
Collapse
Affiliation(s)
- Shen Jun
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center; Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, 160# Pu Jian Ave, Shanghai 200127, China
| | - Liang Jie
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, China
| | - Mao Ren
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ran Zhihua
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center; Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, 160# Pu Jian Ave, Shanghai 200127, China
| |
Collapse
|
8
|
Tse CS, Van Citters AD, Ricci B, Freundlich NZ, Lee M, Shah SA, Melmed GY, Siegel CA, van Deen WK. Identifying and Predicting the Goals and Concerns Prioritised by Individuals with Inflammatory Bowel Disease. J Crohns Colitis 2022; 16:379-388. [PMID: 34350943 DOI: 10.1093/ecco-jcc/jjab142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS In order to provide high-quality care, providers need to understand their patients' goals and concerns. This study aims to identify and predict the goals and concerns prioritised by patients with inflammatory bowel disease [IBD] in the outpatient setting. METHODS Mixed-methods analysis was performed to identify the types, frequencies, and predictors of IBD patients' goals and concerns using 4873 surveys collected over 2016-2019 at 25 gastroenterology clinics across the USA participating in the Crohn's & Colitis Foundation's IBD Qorus Learning Health System. RESULTS Patients with IBD most often prioritised goals and concerns related to symptoms/disease activity [50%] and clinical course/management [20%], whereas psychosocial/quality of life [12%] and medication [6%] concerns were less frequent. Females (odds ratio [OR] 22.1, 95% confidence interval [CI] 5.3-91.5) and patients in clinical remission [OR 2.2, 95% CI 1.2-4.1] were more likely to prioritise family planning. Patients >60 years old [OR 3.1, 95% CI 1.5-6.5] and patients with active disease [OR 3.2, 95% CI 1.4-7.6] were more often concerned about travelling. Smokers were more often concerned about nutrition [OR 4.2, 95% CI 1.9-9.2]. Surgery was more often a concern of patients with perianal Crohn's disease [OR 2.1, 95% CI 1.2-3.5], active disease [OR 1.9, 95% CI 1.1-3.4], and those with recent hospitalisations [OR 2.5, 95% CI 1.2-5.4]. CONCLUSIONS IBD patients prioritised the remission of physical symptoms as treatment goals and they were less frequently concerned about medications and their side effects. Patients' demographics, IBD characteristics, and health care utilisation patterns can predict specific types of concerns/goals.
Collapse
Affiliation(s)
- Chung Sang Tse
- Division of Gastroenterology, University of California San Diego, San Diego, CA, USA
| | - Aricca D Van Citters
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Brittany Ricci
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Moses Lee
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
| | - Samir A Shah
- Brown University, Alpert Medical School, Providence, RI, USA
| | - Gil Y Melmed
- Cedars-Sinai Inflammatory Bowel Disease Center, Karsh Division of Gastroenterology, Cedars-Sinai, Los Angeles, CA, USA
| | - Corey A Siegel
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Welmoed K van Deen
- Cedars-Sinai Medical Center Outcomes Research and Education [CS-CORE], Division of Health Services Research, Department of Medicine, Cedars-Sinai, Los Angeles, CA, USA
| | | |
Collapse
|
9
|
Battat R, Galati JS, Lukin D, Chabouni F, Sockolow R, Carter J, Fajardo K, Yang S, Reich J, Jacobs V, Abramowitz M, Kumar A, Christos P, Longman RS, Burakoff R, Simone L, Sapir T, Crawford CV, Scherl EJ. A Quality Improvement Initiative Is Associated With Reduced Time to Administer Biologics and Small Molecules and Emergency Room Visits in Inflammatory Bowel Disease. J Clin Gastroenterol 2022; 56:e176-e182. [PMID: 35180182 PMCID: PMC8857509 DOI: 10.1097/mcg.0000000000001535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/19/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND Delays in biologic or small molecule medication administration are associated with increased adverse events, hospitalization, and surgery in inflammatory bowel disease (IBD). We evaluated the impact of a quality improvement (QI) intervention on the time to administration of biologics or small molecules (TABS) in IBD. METHODS Data were retrospectively extracted for IBD patients prescribed biologics or small molecules from a convenience sample of providers participating in an accredited QI educational intervention (baseline cohort). Subsequent to the intervention, data were prospectively collected from patients prescribed these medications (postintervention cohort). Dates related to steps between a treatment decision to medication administration were collected. The primary outcome compared TABS in baseline and postintervention cohorts. RESULTS Eighteen physicians provided survey and patient data for 200 patients in each cohort (n=400). The median time to medication administration (TABS) decreased from baseline to postintervention cohorts (30 vs. 26 d, P=0.04). Emergency room visits before medication administration also decreased (25.5% vs. 12.5%, P=0.001). Similar numerical TABS reductions were observed in subgroups limited to physicians providing patients to both cohorts and for individual medications prescribed. Primary contributors to delays included filling prescriptions subsequent to insurance approval and dispensation subsequent to this. CONCLUSIONS A QI intervention successfully reduced medication administration times (TABS) by accelerating provider-dependent steps. This intervention was associated with reduced emergency room visits. We propose TABS as a quality metric to assess the effective delivery of therapies in IBD. Further evaluation of QI interventions, patient education on prescription drug insurance, and quality metrics are warranted.
Collapse
Affiliation(s)
- Robert Battat
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Jonathan S. Galati
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Dana Lukin
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Fatiha Chabouni
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Robbyn Sockolow
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Stevie Yang
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Jenna Reich
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Vinita Jacobs
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Meira Abramowitz
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Anand Kumar
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Paul Christos
- Department of Population Health Sciences Division of Biostatistics and Epidemiology, Weill Cornell Medical College
| | - Randy S Longman
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Robert Burakoff
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Carl V. Crawford
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Ellen J Scherl
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
10
|
Yamamoto-Furusho JK, Andrade D, Barahona J, Bautista S, Bosques-Padilla F, de Paula J, Galiano MT, Iade B, Juliao-Baños F, Otoya G, Steinwurz F, Torres E, Veitia G, Barreiro-de Acosta M. Latin American consensus on the quality indicators for comprehensive care clinics for patients with inflammatory bowel disease: PANCCO-GETECCU. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2022; 87:89-102. [PMID: 34866040 DOI: 10.1016/j.rgmxen.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/18/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) is a chronic and incurable entity. The aim of the Pan American Crohn's and Colitis Organisation (PANCCO) is to create awareness of IBD, with special emphasis on Latin America, and the primary objective of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU, the Spanish acronym) is to obtain the accreditation of the clinical and therapeutic criteria for the diagnosis and treatment of IBD. AIM To carry out a consensus for evaluating the approval criteria that a Comprehensive Care Clinic for Latin American IBD patients must meet, to be considered a center of excellence. MATERIALS AND METHODS Fourteen clinical experts participated in the consensus. They were made up of specialists in gastroenterology, with broad clinical experience, spanning several years, in managing the care of a large number of patients with IBD, as well as advanced specialists in IBD. Thirteen of the participants came from 11 Latin American countries (Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela) that have IBD clinics. An expert from Spain, representing the GETECCU, provided the methodologic support. The consensus consisted of 52 statements divided into three sections: 1) Structure indicators, 2) Process indicators, and 3) Result indicators. The Delphi panel method was applied. RESULTS The present Latin American consensus describes the quality indicators that a Comprehensive Care Clinic for IBD patients must meet, to be considered a center of excellence, taking into account the needs of our region. CONCLUSIONS This is the first Latin American consensus, jointly carried out by the PANCCO and GETECCU, to present accreditation standards for centers of excellence in the care of patients with IBD.
Collapse
Affiliation(s)
- J K Yamamoto-Furusho
- Inflammatory Bowel Disease Clinic, Gastroenterology Department, National Institute of Medical Science and Nutrition Salvador Zubirán, Mexico City, Mexico.
| | - D Andrade
- Servicio de Gastroenterología y Endoscopía Digestiva, Unidad de Intestino Clínica de Enfermedad Inflamatoria Intestinal, Hospital José Carrasco Arteaga, Instituto Ecuatoriano de Seguridad Social, Cuenca, Ecuador
| | - J Barahona
- Enfermedades Digestivas de Guatemala, Ciudad de Guatemala, Guatemala
| | - S Bautista
- CEDIMAT Gastroenterology Center, Santo Domingo, Dominican Republic
| | - F Bosques-Padilla
- Department of Gastroenterology, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - J de Paula
- Gastroenterology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - B Iade
- Unidad de Enfermedad Inflamatoria Intestinal, Hospital Maciel ASSE, CASMU y COSEM, Montevideo, Uruguay
| | - F Juliao-Baños
- Inflammatory Bowel Disease Clinic, Gastroenterology Unit, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - G Otoya
- Private Practice, Lima, Peru
| | - F Steinwurz
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - E Torres
- University of Puerto Rico, San Juan, Puerto Rico
| | - G Veitia
- Gastroenterology Service, Hospital Vargas de Caracas, Caracas, Venezuela
| | - M Barreiro-de Acosta
- Gastroenterology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| |
Collapse
|
11
|
Implementation of an Inpatient IBD Service Is Associated with Improvement in Quality of Care and Long-Term Outcomes. Dig Dis Sci 2021; 66:3753-3759. [PMID: 33474649 DOI: 10.1007/s10620-020-06749-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/25/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is wide variation in the quality of care of hospitalized patients with inflammatory bowel disease (IBD). Prior studies have demonstrated that a specialized inpatient IBD service improves short-term outcomes. In this study, we assessed the impact of a dedicated IBD service on the quality of care and long-term outcomes. METHODS This retrospective cohort study included adult patients admitted for a complication of IBD between March 2017 and February 2019 to a tertiary referral center. In March 2018, a dedicated inpatient IBD service co-managed by IBD gastroenterologists and colorectal surgeons was implemented. Quality of care outcomes included C. difficile stool testing, confirmed VTE prophylaxis administration and opiate avoidance. Long-term outcomes were clinical remission, IBD-related surgery, ED visits, and hospital readmissions at 90 days and 12 months. RESULTS In total, 143 patients were included; 66 pre- and 77 post-implementation of the IBD service. Fifty-two percent had ulcerative colitis and 48% had Crohn's disease. After implementation, there was improvement in C.difficile testing (90% vs. 76%, P = 0.04), early VTE prophylaxis (92% vs. 77%, P = 0.01) and decreases in narcotic use (14% vs. 30%, P = 0.02), IBD-related ED visits at 90 days (7% vs 18%, P = 0.03) and 12 months (16% vs 30%, P = 0.04), and IBD readmissions at 90 days (16% vs. 30%, P = 0.04). There were no differences in rates of clinical remission or surgery. CONCLUSIONS The creation of a dedicated inpatient IBD service improved quality of IBD care and reduced post-discharge ED visits and readmissions and broader implementation of this strategy may help optimize care of hospitalized IBD patients.
Collapse
|
12
|
Park YE, Lee J, Park J, Choi JH, Heo NY, Park SH, Lee YK, Kim TO. Subjective Needs and Thoughts for the Treatment of Patients with Inflammatory Bowel Disease: Applying Q Methodology. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 78:37-47. [PMID: 34312356 DOI: 10.4166/kjg.2021.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/29/2021] [Accepted: 06/21/2021] [Indexed: 12/31/2022]
Abstract
Backgrounds/Aims Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is a chronic inflammatory disorder of the gastrointestinal tract that requires lifetime management. Many studies have attempted to establish questionnaires and/or parameters to assess the quality of care for IBD patients. However, no study to date has investigated patients using the Q-methodology, which is subjective and has been studied systematically, to identify and categorize their opinions and subjective thinking about their disease and treatment. We have therefore aimed here to conduct a preliminary study of the Q-methodology to investigate the subjective thinking of IBD patients in Korea. Methods Q-methodology, a method of analyzing the subjectivity of questionnaire items, was examined in this study. Inputs from 50 IBD patients were classified into 34 normalized statements using a 9-point scale with a normal distribution. The collected data were analyzed using the QUANL PC program. Results Using the Q-methodology, IBD patients were classified into type I, II, III, and IV treatment needs: medical staff-dependent, relationship-oriented, information-driven, and social awareness, respectively. Conclusions The subjective needs of IBD patients and their thoughts about the treatment can be classified into four types. Our findings suggest that we can establish a systematic strategy for personalized care according to patient type.
Collapse
Affiliation(s)
- Yong Eun Park
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jongha Park
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Joon Hyuk Choi
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Nae Yun Heo
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seung Ha Park
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yoon Kyoung Lee
- Division of Quality Management, BAYADA Home Health Care Inc., Seoul, Korea
| | - Tae Oh Kim
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
13
|
Hackett R, Gearry R, Ho C, McCombie A, Mackay M, Murdoch K, Rosser K, Visesio N, Inns S. New Zealand National Audit of Outpatient Inflammatory Bowel Disease Standards of Care. Clin Exp Gastroenterol 2020; 13:285-292. [PMID: 32884323 PMCID: PMC7434564 DOI: 10.2147/ceg.s259790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/29/2020] [Indexed: 12/30/2022] Open
Abstract
Aim This study audits the delivery and standards of New Zealand (NZ) inflammatory bowel disease (IBD) care against international standards, with emphasis on the IBD nursing role. Methods Utilising international standards in IBD care, a 3 phase national multicentre survey study was performed between 2015 and 2019. We 1) evaluated the current role and practices of IBD nurses, 2) evaluated IBD service provision and identified areas for improvement, and 3) audited key aspects of IBD patient care, directly comparing nurse-led and doctor-led outpatient clinics. Results The median duration spent in an IBD nursing role was 21 months (range 2 to 120 months) with the majority (12/15) performing two or more nursing roles. The median IBD nurse full-time equivalent (FTE) was 0.8 (range 0.2 to 1.25). The average number of hours spent undertaking IBD nursing tasks was 22.2 – a 6.8-hour shortfall compared to rostered hours. No service had a per capita IBD multidisciplinary team (MDT) FTE which met international standards. Just under two-thirds (62.5%) of departments held a regular MDT meeting. All responding services could be contacted directly by IBD patients and respond within 48 hours of contact. During 492 doctor-led and 196 nurse-led scheduled outpatient clinic visits, nurses were significantly more likely to document weight, smoking status and organise appropriate colonoscopic surveillance than doctors. Conclusion Multiple nursing job roles resulted in rostered hours being insufficient to complete IBD specific tasks. IBD FTE did not meet international standards. The IBD care was patient-centred, encouraging direct contact from patients with prompt response. IBD nurses in NZ provide high-quality outpatient care when measured against auditable standards. As the IBD nursing role continues to develop, following the implementation of an educational framework and education programme, an increase in numbers is required in order to achieve the recommended minimum FTE per 250 000 population.
Collapse
Affiliation(s)
- Robert Hackett
- Department of Gastroenterology, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Richard Gearry
- Department of Gastroenterology, Canterbury District Health Board, Christchurch, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Christine Ho
- Department of Gastroenterology, Southern District Health Board, Dunedin, New Zealand
| | - Andrew McCombie
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Megan Mackay
- Department of Gastroenterology, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Karen Murdoch
- Department of Gastroenterology, Hawkes Bay District Health Board, Hastings, New Zealand
| | - Kirsten Rosser
- Department of Gastroenterology, Canterbury District Health Board, Christchurch, New Zealand
| | - Nideen Visesio
- Department of Gastroenterology, Waitemata District Health Board, Auckland, New Zealand
| | - Stephen Inns
- Department of Gastroenterology, Hutt Valley District Health Board, Lower Hutt, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW The cost of care for inflammatory bowel disease (IBD) has nearly doubled over the last two decades. With evolving treatment paradigms utilizing costly but efficacious biologic agents earlier and more often, the cost burden is only expected to worsen. The purpose of this review is to explore the current economic landscape and drivers of IBD healthcare costs along with potential mechanisms for improving value and cost-effectiveness of IBD care. RECENT FINDINGS The prevalence of IBD continues to rapidly expand with costs following suit. As compensation models change, the medical community is more incentivized than ever to develop cost reduction strategies including incorporation of high-value care measures, cooperative data aggregation, and technological solutions, with many of these interventions demonstrating promising results. SUMMARY IBD is an expensive chronic disease with payments only expected to rise. In light of this financial conundrum, new practice models, such as the IBD specialty medical home and remote telemedicine, are being tested with an emphasis on cost reduction. Many of these strategies are demonstrating improved patient outcomes while also curbing expenses. These early successes set the stage for continued cooperation, collaboration, and growth in value-based management of IBD.
Collapse
|
15
|
Weissman S, Goldowsky A, Mehta TI, Sciarra MA, Feuerstein JD. Are Quality Metrics in Inflammatory Bowel Disease Rooted on Substantial Quality Evidence? A Systematic Review. J Crohns Colitis 2020; 15:jjaa123. [PMID: 32544248 DOI: 10.1093/ecco-jcc/jjaa123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Quality metrics were established to develop standards to help assess quality of care, yet variation in inflammatory bowel disease (IBD) clinical practice exists. We performed a systematic review to assess the overall quality of evidence cited in formulating IBD quality metrics. METHODS A systematic search was performed on PubMed, MEDLINE, and EMBASE. All major national and international IBD societies were included. Quality metrics were assessed for evidence quality and categorized as category A (guideline based), category B (primarily retrospective and observational studies) or category C (expert opinion). Quality metrics were examined for the type of metric, the quality, measurability, review, existing conflicts of interest (COI), and patient participation of the metric. Statistical analysis was conducted in R. RESULTS A total of 143 distinct, and an aggregate total of 217 quality metrics were included and analyzed. 68%, 3.2%, and 28.6% of IBD quality metrics were based on low, moderate, and high quality of evidence, respectively. The proportion of high quality evidence across societies was significantly different (P <0.01). Five organizations included patients in quality metric development, three reported external review, not all reported measurable outcomes or stated the presence of a COI. Finally, 43% of quality metrics were published more than 5 years ago. CONCLUSIONS Quality metrics are important to standardize practice. As more than two-thirds of the quality metrics in IBD are based on low quality evidence, further studies are needed to improve the overall quality of evidence supporting the development of quality measures.
Collapse
Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health, Palisades Medical Center, North Bergen, New Jersey, USA
| | - Alexander Goldowsky
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tej I Mehta
- Department of Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Michael A Sciarra
- Division of Gastroenterology and Hepatology, Hackensack Meridian Health, Palisades Medical Center, North Bergen, New Jersey, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Lin X, Lofland J, Zhang L, Sloan S, Chamaa L, Marano C, Plevy S. Opioid Use in Patients With Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2020; 2:otaa009. [PMID: 36777960 PMCID: PMC9802313 DOI: 10.1093/crocol/otaa009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
Background Data on opioid use in patients with inflammatory bowel disease and the relationship between disease, opioid use, and healthcare resource utilization are needed. Methods This analysis of real-world data from IBM Watson Health Commercial Claims and Encounters Database included patients with the first claim of inflammatory bowel disease (IBD) between 2007 and 2014. Results Opioid use was higher in patients with IBD than in the matched non-IBD cohort. Adjusted for age, gender, and Charlson Comorbidity Index score, inpatient and emergency room visits risk was higher in opioid users than non-users in both IBD cohorts. Conclusions Opioid use could be a potential surrogate for inadequate disease control manifested by increased inpatient and emergency room visit risks. These results suggest a need exists for better disease management and the development of an outcomes measurement tool for IBD pain.
Collapse
Affiliation(s)
- Xiwu Lin
- Quantitative Sciences, Janssen Pharmaceutical Research & Development, LLC., Spring House, Pennsylvania, USA,Address correspondence to: Xiwu Lin, PhD, 1400 McKean Road, Spring House, PA 19477 ()
| | | | - Ling Zhang
- Quantitative Sciences, Janssen Pharmaceutical Research & Development, LLC., Spring House, Pennsylvania, USA
| | - Sheldon Sloan
- Janssen Global Services, LLC., Horsham, Pennsylvania, USA
| | - Laila Chamaa
- Janssen Global Services, LLC., Horsham, Pennsylvania, USA
| | - Colleen Marano
- Immunology, Janssen Pharmaceutical Research & Development, LLC., Spring House, Pennsylvania, USA
| | - Scott Plevy
- Immunology, Janssen Pharmaceutical Research & Development, LLC., Spring House, Pennsylvania, USA
| |
Collapse
|
17
|
Beard JA, Franco DL, Click BH. The Burden of Cost in Inflammatory Bowel Disease: A Medical Economic Perspective and the Future of Value-Based Care. Curr Gastroenterol Rep 2020; 22:6. [PMID: 32002671 DOI: 10.1007/s11894-020-0744-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW To examine the quantifiable economic impact of inflammatory bowel disease (IBD), key cost drivers and determinants, and the impact of value-based care in IBD. Finally, we prognosticate on future directions and opportunities on healthcare economics in IBD. RECENT FINDINGS New value-based initiatives, technologically driven interventions, and quality improvement programs have demonstrated reductions in healthcare utilization and enhanced patient outcomes, and several have realized cost of care reductions. IBD is a costly, chronic illness with unbalanced spending by a small proportion of individuals. Pharmaceutical costs are overtaking inpatient expenses as the primary cost driver. Value-based care initiatives including the IBD medical home, remote monitoring platforms such as myIBDcoach and Project Sonar, and learning healthcare networks exemplified by ImproveCareNow have all demonstrated successes in improving care quality, patient outcomes, and reduced healthcare spending in some populations. The future of value-based care in IBD is bright, with ample opportunities for model refinement, collaboration, and growth.
Collapse
Affiliation(s)
- Jonathan A Beard
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Diana L Franco
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin H Click
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
18
|
Click B, Regueiro M. The Inflammatory Bowel Disease Medical Home: From Patients to Populations. Inflamm Bowel Dis 2019; 25:1881-1885. [PMID: 30934057 DOI: 10.1093/ibd/izz062] [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: 01/29/2019] [Indexed: 12/14/2022]
Abstract
With increasing emphasis on cost reduction and quality improvement, the transition to value-based care is underway. New models of health care delivery are being explored to optimize patient experience and outcomes while decreasing health care expenses. One such model is the specialty medical home (SMH), which provides multidisciplinary, high-quality care for chronic diseases with specialist involvement, such as inflammatory bowel disease (IBD). This review aims to explore the rationale behind initial construction, the critical personnel and components, the early outcomes of established models, comparison with other value-based care models, and the role of an IBD SMH in population health management.
Collapse
Affiliation(s)
- Benjamin Click
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
19
|
Han M, Jung YS, Cheon JH, Park S. Regional variations in the use of biologics and immunomodulators among Korean patients with inflammatory bowel diseases. J Gastroenterol Hepatol 2019; 34:1166-1174. [PMID: 30672608 DOI: 10.1111/jgh.14609] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/01/2019] [Accepted: 01/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Variation in medical care can be an obstacle to improving quality and outcome of treatment. We conducted a nationwide, population-based study to identify regional variations in medication prescription rates in Korean patients with inflammatory bowel diseases (IBDs). METHODS Using the National Health Insurance claims, we collected data on patients diagnosed with IBD (8974 cases of Crohn's disease [CD] and 17 167 cases of ulcerative colitis [UC]) between 2010 and 2016. RESULTS Overall rates of biologics (infliximab or adalimumab) use in CD and UC were 19.6% and 6.1%, respectively, and those of immunomodulator (azathioprine or 6-mercaptopurine) use were 66.9% and 20.4%, respectively. The average periods from diagnosis to first biologics use for CD and UC were 1.6 and 1.8 years, respectively, and those of immunomodulators were 0.6 and 1.3 years, respectively. In Seoul, Daegu, and Busan, three major cities in Korea, biologics prescription rates for CD were 20.7%, 22.9%, and 14.6%, respectively, and those for UC were 7.3%, 6.7%, and 4.5%, respectively. In the top 7 regions with the highest number of patients in Seoul, there were 3.6-fold and 3.2-fold variations between regions with the highest and lowest frequency of biologics use in CD and UC, respectively. In addition, there were 1.6-fold and 2.8-fold variations between regions with the highest and lowest frequency of immunomodulator use for CD and UC, respectively. CONCLUSIONS Regional variation exists in medication prescription rates within a single city as well as nationwide, suggesting that standardization of IBD treatment is necessary in Korea.
Collapse
Affiliation(s)
- Minkyung Han
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
| | - Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sohee Park
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Korea
| |
Collapse
|
20
|
Ye BD, Travis S. Improving the quality of care for inflammatory bowel disease. Intest Res 2019; 17:45-53. [PMID: 30449081 PMCID: PMC6361018 DOI: 10.5217/ir.2018.00113] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/05/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
Great strides have been achieved in the development of quality-of-care measures and standards for inflammatory bowel disease (IBD) over the last decade. The central structural component of care in IBD revolves around the multidisciplinary team, which should be equipped with the necessary resources to operate and implement decisions. Process measures have been defined by interest groups and can be adapted into process tools for the delivery of care for various patient subgroups and clinical scenarios. The emerging treat-to-target approach to IBD management may be used to achieve optimal long-term and holistic patient-centred outcomes, such as survival, control of inflammation and disease progression, symptomatic remission, quality of life and complications. Other important quality-of-care outcome measures for IBD include disutility of care, healthcare utilization and other patient-reported outcomes such as nutritional status and impact of fistulae. The current challenge for healthcare providers and health systems is the integration of quality-of-care structures and processes into clinical practice, and the consistent delivery of updated evidence-based quality IBD care to various patient populations by individual health care providers. Finally, the awareness and appreciation for quality of care in IBD is increasing in Asia, and Asian healthcare institutions should be encouraged to take the lead in improving the quality of care in IBD.
Collapse
Affiliation(s)
- Byong Duk Ye
- Department of Gastroenterology and Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Simon Travis
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| |
Collapse
|
21
|
Georgy M, Negm Y, El-Matary W. Quality improvement in healthcare for patients with inflammatory bowel disease. Transl Pediatr 2019; 8:77-82. [PMID: 30881901 PMCID: PMC6382498 DOI: 10.21037/tp.2019.01.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Since inflammatory bowel diseases (IBD) are chronic disorders with typical remission and relapses and no cure, maintaining high quality of provided healthcare to patients with IBD plays a major role in the management and reducing disease-related morbidity. To hone process-based quality indicators in order to ameliorate quality of care, the indicators must be based on high quality evidence and expert consensus. ImproveCareNow (ICN) group gave us a great example of quality improvement (QI) by gaining experience in how to exercise, apply and implement QI methods in the care of children with IBD. "The American Gastroenterological Association" has developed an adult "IBD physician performance measures set" and both "Crohn's and Colitis Foundation of America" (CCFA) and "Crohn's and Colitis Canada" (CCC) have developed sets of most highly rated process and outcome measures. "The Emerging Practice in IBD Collaborative (EPIC) Canadian group" developed definitions of quality indicators for best-practice management of IBD in Canada. "Quality of Care through the Patient's Eyes (QUOTE-IBD)" was honed as a questionnaire to quantify quality of care in the eyes of patients with IBD. This is now widely used in several European countries. The current concepts of quality of care as well as quality indicators will be discussed in this article.
Collapse
Affiliation(s)
- Michael Georgy
- Section of Pediatric Gastroenterology, Winnipeg Children's Hospital, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Yasser Negm
- Section of Pediatric Gastroenterology, Winnipeg Children's Hospital, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Wael El-Matary
- Section of Pediatric Gastroenterology, Winnipeg Children's Hospital, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| |
Collapse
|
22
|
Park S, Chun J, Han KD, Soh H, Choi K, Kim JH, Lee J, Lee C, Im JP, Kim JS. Increased end-stage renal disease risk in patients with inflammatory bowel disease: A nationwide population-based study. World J Gastroenterol 2018; 24:4798-4808. [PMID: 30479466 PMCID: PMC6235796 DOI: 10.3748/wjg.v24.i42.4798] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/17/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To estimate the risk of end-stage renal disease (ESRD) in patients with inflammatory bowel disease (IBD).
METHODS From January 2010 to December 2013, patients with Crohn’s disease (CD) and ulcerative colitis (UC) were identified, based on both the International Classification of Diseases, 10th revision (ICD-10) and the rare, intractable disease registration program codes from the National Health Insurance (NHI) database in South Korea. We compared 38812 patients with IBD to age- and sex-matched non-IBD controls with a ratio of 1:3. Patients newly diagnosed with ESRD were identified with the ICD-10 code.
RESULTS During a mean follow-up of 4.9 years, ESRD was detected in 79 (0.2%) patients with IBD and 166 (0.1%) controls. The incidence of ESRD in patients with IBD was 0.42 per 1000 person-years. Patients with IBD had a significantly higher risk of ESRD than controls [adjusted hazard ratio (HR) = 3.03; 95% confidence interval (CI): 1.77-5.20; P < 0.001]. The incidences (per 1000 person-years) of ESRD were 0.51 in patients with CD and 0.13 in controls, respectively (adjusted HR = 6.33; 95%CI: 2.75-14.56; P < 0.001). In contrast, the incidence of ESRD was similar between the UC and control groups (0.37 vs 0.37 per 1000 person-years; adjusted HR = 2.01; 95%CI: 0.90-4.51; P = 0.089).
CONCLUSION The risk of ESRD was elevated in patients with CD, but not UC. Patients with CD should be monitored carefully for signs of renal insufficiency.
Collapse
Affiliation(s)
- Seona Park
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Jaeyoung Chun
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Hosim Soh
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Kookhwan Choi
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Ji Hye Kim
- Department of Internal Medicine, CHA Gangnam Medical Center, CHA University, Seoul 06135, South Korea
| | - Jooyoung Lee
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, South Korea
| | - Changhyun Lee
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, South Korea
| | - Jong Pil Im
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Joo Sung Kim
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| |
Collapse
|
23
|
Kochar B, Herfarth HH. Vaccinations in Adult Patients with Inflammatory Bowel Diseases in the West. Inflamm Intest Dis 2018; 3:11-15. [PMID: 30505837 PMCID: PMC6266030 DOI: 10.1159/000491752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/02/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patients with moderate-severe inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis are commonly treated with long-term immunosuppressive therapies involving immunomodulators such as thiopurines, biologics (anti-TNF and anti-adhesion molecules), or novel small molecules such as Janus kinase inhibitors. SUMMARY Some infections seen with immunosuppressive therapy in IBD are preventable with vaccines. IBD-specific immunosuppressive therapy is generally initiated by gastroenterologists. Therefore, gastroenterologists should comprehend the appropriate application of vaccines such as hepatitis B, pneumonia, and herpes zoster vaccinations. This review summarizes the current guidance for vaccinations of IBD patients in the United States. KEY MESSAGE Gastroenterologists treating IBD patients must be aware of necessary vaccination schedules in the setting of immunosuppressive therapies.
Collapse
Affiliation(s)
- Bharati Kochar
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hans H. Herfarth
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
24
|
Perry J, Chen A, Kariyawasam V, Collins G, Choong C, Teh WL, Mitrev N, Kohler F, Leong RWL. Medication non-adherence in inflammatory bowel diseases is associated with disability. Intest Res 2018; 16:571-578. [PMID: 30301333 PMCID: PMC6223449 DOI: 10.5217/ir.2018.00033] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023] Open
Abstract
Background/Aims Medication non-adherence is common in inflammatory bowel diseases (IBD). The short-term consequences of non-adherence include increased disease relapse but the long-term impact upon patients in terms of daily functional impairment are less well characterized. Identifying negative outcomes, such as disability, may encourage adherence. Methods Consecutive ambulatory IBD subjects completed the Medication Adherence Rating Scale (MARS; non-adherence defined as ≤16), Inflammatory Bowel Diseases Disability Index (IBD-DI; disability: <3.5) and Beliefs about Medicines Questionnaire (high necessity/concerns: ≥16). The primary outcome was the association between medication non-adherence and disability. Secondary outcomes were the predictors of these outcomes. Results A total of 173 subjects on IBD maintenance medications were recruited (98 Crohn's disease, 75 ulcerative colitis: median IBD-DI, -5.0; interquartile range [IQR], -14.0 to 4.0 and median MARS, 19.0; IQR, 18 to 20) of whom 24% were non-adherent. Disability correlated significantly with medication non-adherence (r=0.38, P<0.0001). Median IBD-DI for non-adherers was significantly lower than adherers (-16.0 vs. -2.0, P<0.0001). Predictors of disability included female sex (P=0.002), previous hospitalization (P=0.023), management in a referral hospital clinic (P=0.008) and medication concerns (P<0.0001). Non-adherence was independently associated with difficulty managing bowel movements (odds ratio [OR], 3.71; 95% confidence interval [CI], 1.50-9.16, P=0.005), rectal bleeding (OR, 2.69; 95% CI, 1.14-6.36; P=0.024) and arthralgia/arthritis (OR, 2.56; 95% CI, 1.11-5.92; P=0.028). Conclusions Medication non-adherence was associated with significantly increased disability in IBD. Female gender, higher disease severity and medication concerns were additional predictors of disability.
Collapse
Affiliation(s)
| | - Andy Chen
- Faculty of Medicine, University of New South Wales, Australia
| | - Viraj Kariyawasam
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - Glen Collins
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - Chee Choong
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - Wei Ling Teh
- Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| | - Nikola Mitrev
- Sydney Medical School, University of Sydney, Australia
| | | | - Rupert Wing Loong Leong
- Sydney Medical School, University of Sydney, Australia.,Faculty of Medicine, University of New South Wales, Australia.,Gastroenterology and Liver Services, Concord Hospital, Sydney, Australia
| |
Collapse
|