Inflammatory Bowel Disease (IBD) requires lifelong monitoring that is mostly offered in hospitals. The demand for outpatient clinic appointments continues to increase in parallel to the increasing prevalence of IBD, resulting in delays in accessing medical care.Background
We developed a patient centred pathway that stratifies care according to clinical needs as part of a quality improvement project. The first step was to engage patients aiming to develop a patients’ information leaflet (PIL) to inform about our initiative and determine their preferred type of follow up depending on their clinical state.Methods
We used the National Institute for Health Research Collaboration for Leadership and Applied Healthcare Research for quality improvement methodology namely Plan-Do-Study-Act cycles (PDSA). The first version PIL and questionnaire was tested on patients attending clinic on week 1 (plan). PIL was distributed to patients (do) and feedback collated (study) including PIL readability using FK reading ease score. The PIL was adjusted (act) and the cycle repeated until no more changes were necessary. A structured questionnaire was developed to assess patients‘ preferred type of follow up and was distributed to sequential patients attending non-complex IBD clinics. Patients opting for out of hospital follow up, would have their care transferred to the telephone clinic if they were in remission according to the physician’s global assessment.Results
The FK Reading ease score of the first PIL was 53.5. After 1 PDSA cycle, it increased to 64.5. Sequential reviews of the document up to 15th version resulted in a final score of 65.8. (Figure)Results
12 patients reviewed the document. All agreed that the information provided was readable, adequate and useful. At 5 months, 107 patients completed the questionnaire. The mean (SD) age was 52.1 (16.1) years. 62 (58%) preferred hospital monitoring for remission compared with 45 (42%) who preferred outside hospital care (telephone clinic, community services, eHealth). For active disease 45% of patients would still prefer to be given advice over the phone. Overall, 21 patients in remission were identified as appropriate to have their care transferred in our telephone clinic in the first phase of our improvement plan.Conclusions
In the first steps of our quality improvement plan, we show the value of patient involvement on designing PIL. We show that out of hospital follow up is a viable option for a select group of patients. The next step is to assess the impact of out of hospital monitoring on quality of care.