Clinical decision support improves quality of care in patients with ulcerative colitis

Abstract

Background: Decision support tools may facilitate shared decision-making and improve quality of care.Aim: To assess the effectiveness of a decision support tool on improving quality of care in ulcerative colitis. Methods:A prospective quality of care intervention was conducted at two Australian hospitals comparing out-patient-based ulcerative colitis care with, and without, a tabletbased decision support tool. This included questions on disease activity management; psychological well-being; and preventive care, with 13 process indicators relevant to each domain. Participants included adult out-patients with mild-to-moderate ulcerative colitis and their clinicians who were divided into two cohorts. The first cohort were followed up immediately after their clinical review to check whether their clinician had discussed the 13 process indicators during the consultation. The second cohort of patients used the decision support tool immediately prior to their consultation which then generated a suggested management plan for the patient and clinician to discuss during the consultation. Management between the 2 cohorts was compared to assess the effectiveness of the decision support tool in improving the primary outcome, defined as the proportion of quality process indicators used for ulcerative colitis care, with and without the decision support tool. Results:Thirteen physicians and 100 patients participated. Fifty patients were managed without the decision support tool using standard care (median age 40; 44% male), and 50 patients used the decision support tool (median age 40; 46% male) over a 20-week period.Increase in the median use of process indicators overall was observed following use of the decision support tool (27% vs 100%; P < 0.001). Improvements were seen in psychological well-being management (30% vs 100%; P < 0.001), preventive care (16% vs 100%; P < 0.001) and process indicators related to disease activity management (50% vs 100%; P < 0.001). The decision support tool was found to be usable and acceptable. Shared decision-making was greater in the post-intervention group (mean decision conflict score of 18.0 vs 33.5; P = 0.002). Conclusions:The decision support tool substantially improved the quality of the delivery of care. Decision support tools have the potential to minimise errors of omission via a standardised approach to care.

Telehealth and mobile health interventions in adults with inflammatory bowel disease: A mixed‐methods systematic review

“…The disease activity significantly improved (i.e., participants went into remission) in one nonrandomized quantitative study ( p < .001; Jackson et al, 2019), but decreased in two RCTs (Cross et al, 2012; Del Hoyo et al, 2018) even though the difference was not statistically significant. As to patients' relapse episodes, the proportions of occurrence were nearly equal in the web‐based UC group (51%) and the control (52%) group (Elkjaer et al, 2010).…”

“…Of the 18 studies, eight (Abutaleb et al, 2018; Cross et al, 2019; de Jong et al, 2017; Del Hoyo et al, 2018; Krier et al, 2011; Li et al, 2017; Ruf et al, 2019; Sebastian et al, 2019) included adults with IBD of both subtypes (CD & UC), and participants with active disease and remission (inactive disease). Six of the studies (Cross et al, 2012; Elkjaer et al, 2010; Jackson et al, 2019; Pederson et al, 2014; Sebastian et al, 2019; Walsh et al, 2019) included participants with UC only; three of these studies included participants with mild to moderate UC (Elkjaer et al, 2010; Jackson et al, 2019; Pederson et al, 2014), and one study included subjects with CD (Pederson et al, 2012) who were in remission and or active disease. The study by Bager (2014) only selected adults with IBD in remission.…”

“…The reviewed studies measured clinical disease activity using validated instruments based on participants' self‐report. The instruments included the Simple Clinical Colitis Activity Index (SCCAI; Cross et al, 2019; Del Hoyo et al, 2018; Elkjaer et al, 2010; Jackson et al, 2019; Pederson et al, 2014), Seo Index for participants with UC (Cross et al, 2012), and Harvey–Bradshaw Index (HBI) for participants with CD (Cross et al, 2019; Del Hoyo et al, 2018).…”

“…Patient satisfaction with telehealth and mHealth interventions were reflected in many of the quantitative studies. The majority of the participants (>75%) from many studies reported satisfaction with telehealth and mHealth interventions (Bager, 2014; Elkjaer et al, 2010; Jackson et al, 2019; Pederson et al, 2012; Sebastian et al, 2019). In alignment with these findings, participants reported having enough time to spend with their physicians through telemedicine virtual visits (Li et al, 2017).…”

A Web-Based Decision Aid (myAID) to Enhance Quality of Life, Empowerment, Decision Making, and Disease Control for Patients With Ulcerative Colitis: Protocol for a Cluster Randomized Controlled Trial

“…SDM helps the doctor and the patient to collaborate on management decisions, which can lead to improved quality of life (QoL) and likelihood of achieving health goals, while lowering the demand for health care resources and improving patients’ health care experience [ 7 ]. Many health care organizations have embraced SDM as an important part of health care standards and patient-centered care [ 8 - 10 ].…”