742 Quality Improvement in IBD Care: The Influence of a QI Specific Conference for Fellows

Abstract

INTRODUCTION: Given the complexity of management of inflammatory bowel disease (IBD), medical societies such as the American Gastroenterological Association (AGA) and Crohn's and Colitis Foundation of America (CCFA) have established measures aimed at defining quality of care. In 2011, the AGA proposed 10 quality metrics for IBD, eight of these measures relate to outpatient management and two focus on inpatient management. Our objective was to evaluate compliance with these measures in our own general GI practice and determine whether a GI conference discussing quality improvement (QI) in 2017 was effective. METHODS: The 8 AGA IBD core measures related to the outpatient management of IBD were assessed. From a list of patients with ICD-9 codes for IBD, We identified 104 patients with well documented Crohn's disease (CD) or ulcerative colitis (UC) and multiple visits through 2018. For this quality assessment, we used the most recent GI visit and. The patients were divided into two groups (most recent visit prior (Pre) or after (Post) a GI conference in 2017. Significant differences were defined using student's t-test or Pierson Chi-square. RESULTS: There were 40 patients in the pre group and 64 patients in the post group. The gender and racial distribution were not significantly different between pre and post (70% pre vs 61% post female; 75% vs 73% AA). There were more CD patients in the post group (48% vs 70% P < 0.05) and more patients were on an anti-TNF biologics (18% vs 41%). Table 1 details the results of the quality measures before and after the QI conference. Prior to the QI conference in 2017, there were areas for improvement (i.e., <75% compliance) in 4 of the categories Bone density screening, screening for Vit D deficiency, documenting disease severity, vaccinations and tobacco cessation counseling (Table 1). Following the QI conference discussion in 2017, there was good improvement seen several areas. Although, there were small improvements in vaccinations, the numbers are still very low. CONCLUSION: We demonstrated improved compliance with the AGA IBD quality metrics after the QI conference, though there are still areas of improvement for documenting immunizations and tobacco cessation counselling. To help improve compliance with core measures, we propose advocating for our current EMR systems to have the ability to trigger alerts regarding specific measures and improve compliance as well as educating new fellows on proper documentation and standardization of the AGA IBD quality metrics.

Interventions to Decrease Unplanned Healthcare Utilization and Improve Quality of Care in Adults With Inflammatory Bowel Disease: A Systematic Review

“…44 Eight studies explored the effects of physician education interventions on vaccination rates. [26][27][28][29]31,32,36,39 These varied from educational sessions and materials to one-on-one audit review sessions with gastroenterologists. Three included only fellows, and 2 incorporated EMR or documentation changes in the same intervention.…”

“…Overall, these interventions showed mixed results, with 6 of these studies reporting improvement in vaccination for at least one of influenza or pneumococcal vaccinations. 26,27,29,32,36,39 Focusing on patient instead of physician education, Reich et al 34 randomized patients to receive IBD education materials or non-IBD-related information via EMR messaging. The group that received IBD-specific information, including vaccination reminders, had greater changes in the rates of both influenza and pneumococcal vaccination than the control group, despite high baseline rates of vaccination at the start of the study.…”

“…Ten studies, all of which also addressed vaccinations, examined the rate of appropriate testing before the initiation of therapy with an anti-TNF therapy or thiopurine (Table 2). 24,26,27,29,31,36,37,39,40,42 Six studies included the use of structured documentation via an EMR template to improve screening for latent TB and/or hepatitis B status to mixed success, and 3 of 4 works examining the rate of TPMT assessment found no change in its completion rate. 24,26,29,31,37,39,40 In 2 related studies examining the effects of intensive physician education, including a one-on-one audit session, one found improvements and the other did not, although one used a pre/post design and the other used a comparator group.…”

“…24,26,27,29,31,36,37,39,40,42 Six studies included the use of structured documentation via an EMR template to improve screening for latent TB and/or hepatitis B status to mixed success, and 3 of 4 works examining the rate of TPMT assessment found no change in its completion rate. 24,26,29,31,37,39,40 In 2 related studies examining the effects of intensive physician education, including a one-on-one audit session, one found improvements and the other did not, although one used a pre/post design and the other used a comparator group. 27,36 One work explored the effect of an educational session on IBD quality measures for fellows and found that this increased rates of hepatitis B virus but not TB assessment.…”

“…Eight works examined the effect of interventions on the use of steroid-sparing therapy and reduction of overall steroid utilization (Table 4). 26,[39][40][41][54][55][56][57] In one, Feuerstein et al 26 found that a combination of physician education programming and changes in clinical documentation led to an increase in rates of reported steroid-sparing therapy in both an academic medical center and a private practice (74% to 100% and 78% to 100%, respectively; both P < .001). Melmed et al 55 reported on the efforts of the QORUS learning health system collaborative, which showed a significant overall reduction in steroid use from 14% to 10% across all sites.…”