Background: To achieve clinical remission and endoscopic healing in inflammatory bowel diseases (IBD) a multidisciplinary approach combined with optimized patient stratification, monitoring strategies and re-evaluating clinical care pathways is needed constituting to quality of care (QoC). The aim of this study was to evaluate structural, access/process components and link these to outcome quality indicators (QIs) in our tertiary referral IBD center.
Methods: In the first phase structural/process components of our IBD center 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 (248 CD/125 UC, 52/52% females, median age 35/39 years). Ileocolonic location, complicated disease behavior and perianal disease was 62.1, 49.6, and 45.9% of CD patients, 72.1% of UC patients had extensive disease.
Results: Structural components of our IBD center met the requirements (3 gastroenterologists with IBD interest, access to surgeon and radiology, regular multidisciplinary meetings) with the exception of the IBD nurse. Process indicators are part of standard operational processes (e.g. urgent outpatient access for suspected flare, evaluation of newly diagnosed patients, tracking of medications and surgical history, latent TB testing before immunosuppression or biologicals). Initial assessment: all patients underwent a full colonoscopy while ileocolonoscopy/gastroscopy was performed in 81.8/45.5% of CD patients, CT/MRI in 66.1/49.6% of CD patients and pelvic MRI in 83.1% in patients with perianal disease. Patients with a flare (CD/UC: 50.6/54.6%) after 2014, had an outpatient consultation with specialist at the IBD clinic within a median of 1 day with same day laboratory testing and abdominal US, CT scan/surgical consult and change in medical therapy if needed. Medical therapy was changed in 51.9/59.4% of CD/UC patients (initiation of steroids: 41.5/69.8%, AZA: 18.1/7.5% anti-TNF/dose intensification: 29.6/19.7% and 25.5/21.4%). 20.1% of CD patients required any surgery, 1.4% colectomy in UC, 17.3/3.2% of CD/UC patients required hospitalization. A total of 86.7% of CD patients had any imaging evaluation after 2014 (US: 49.7%, CT: 5.6% and MRI: 39.3%, colonoscopy: 45.5%), while 51.1% and 35.9% of UC patients underwent colonoscopy and abdominal US. The median waiting time for non-emergency endoscopy/CT/MRI was 16, 14 and 22 days.
Conclusions: Prospective continuous tracking and formal evaluation of structural, process/access and outcome parameters of QoC in IBD centers is important. Measurement of QIs and patient satisfaction improves healthcare delivery and efficiency and leads to improved patient outcomes.