TY - JOUR
T1 - Interventions to Decrease Unplanned Healthcare Utilization and Improve Quality of Care in Adults With Inflammatory Bowel Disease
T2 - A Systematic Review
AU - Fudman, David I.
AU - Perez-Reyes, Andrea Escala
AU - Niccum, Blake A.
AU - Melmed, Gil Y.
AU - Khalili, Hamed
N1 - Funding Information:
Conflicts of interest These authors report the following: Dr Fudman reports serving as a consultant for Pfizer. Dr Melmed reports consulting for AbbVie, Arena, Boehringer-Ingelheim, Bristol-Meyers Squibb/Celgene, Entasis, GlaxoSmith Kline, Janssen, Medtronic, Pfizer, Samsung Bioepis, Takeda, and Techlab. Dr Khalili reports serving as a consultant for Takeda and AbbVie and receiving grant support from Takeda and Pfizer. The remaining authors disclose no conflicts.
Funding Information:
David I. Fudman, MD (Conceptualization: Lead; Data curation: Lead; Formal analysis: Lead; Methodology: Equal; Writing ? original draft: Lead; Writing ? review & editing: Equal), Andrea Escala Perez-Reyes (Data curation: Equal; Formal analysis: Supporting; Writing ? original draft: Supporting; Writing ? review & editing: Equal), Blake A. Niccum (Data curation: Supporting; Writing ? review & editing: Equal), Gil Y. Melmed (Formal analysis: Supporting; Writing ? review & editing: Equal), Hamed Khalili (Conceptualization: Supporting; Data curation: Supporting; Formal analysis: Supporting; Methodology: Equal; Supervision: Supporting; Writing ? review & editing: Equal) Conflicts of interest These authors report the following: Dr Fudman reports serving as a consultant for Pfizer. Dr Melmed reports consulting for AbbVie, Arena, Boehringer-Ingelheim, Bristol-Meyers Squibb/Celgene, Entasis, GlaxoSmith Kline, Janssen, Medtronic, Pfizer, Samsung Bioepis, Takeda, and Techlab. Dr Khalili reports serving as a consultant for Takeda and AbbVie and receiving grant support from Takeda and Pfizer. The remaining authors disclose no conflicts.
Publisher Copyright:
© 2021 AGA Institute
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - Crohn's
KW - Inflammatory Bowel Disease
KW - Quality Improvement
KW - Quality Metric
KW - Ulcerative Colitis
UR - http://www.scopus.com/inward/record.url?scp=85121904845&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85121904845&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2021.08.048
DO - 10.1016/j.cgh.2021.08.048
M3 - Review article
C2 - 34481951
AN - SCOPUS:85121904845
SN - 1542-3565
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
ER -