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ImproveCareNow: The development of a pediatric inflammatory bowel disease improvement network

Crandall, Wallace MD1; Kappelman, Michael D. MD, MPH2; Colletti, Richard B. MD3; Leibowitz, Ian MD4; Grunow, John E. MD5; Ali, Sabina MD6; Baron, Howard I. MD7; Berman, James H. MD8; Boyle, Brendan MD1; Cohen, Stanley MD9; del Rosario, Fernando MD10; Denson, Lee A. MD11; Duffy, Lynn MD4; Integlia, Mark J. MD12; Kim, Sandra C. MD2; Milov, David MD10; Patel, Ashish S. MD13; Schoen, Bess T. MD9; Walkiewicz, Dorota MD14; Margolis, Peter MD, PhD15

doi: 10.1002/ibd.21394
Pediatric Review Articles

There is significant variation in diagnostic testing and treatment for inflammatory bowel disease. Quality improvement science methods can help address unwarranted variations in care and outcomes.

Methods:: The ImproveCareNow Network was established under the sponsorship of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the American Board of Pediatrics as a prototype for a model of improving subspecialty care that included three components: 1) creating enduring multicenter collaborative networks of pediatric subspecialists, 2) sharing of performance data collected in patient registries, and 3) training in quality improvement. The network began with a focus on improving initial diagnostic testing and evaluation, the classification of the severity and extent of disease, the detection and treatment of inadequate nutrition and growth, and the appropriate dosing of immunomodulator medications. Changes are based on an evidence‐based model of chronic illness care involving the use of patient registries for population management, previsit planning, decision support, promoting self‐management, and auditing of care processes.

Results:: Currently, patients are being enrolled at 23 sites. Through 2009, data have been analyzed on over 2500 patients from over 7500 visits. Initial results suggest improvements in both care processes (e.g., appropriate medication dosing and completion of a classification bundle that includes the patient's diagnosis, disease activity, distribution and phenotype, growth status, and nutrition status) and outcomes (e.g., the percentage of patients in remission).

Conclusions:: These improvements suggest that practice sites are learning how to apply quality improvement methods to improve the care of patients. (Inflamm Bowel Dis 2011;)

1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus Ohio

2Department of Pediatrics, Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

3Department of Pediatrics, Vermont Children's Hospital and University of Vermont College of Medicine, Burlington, Vermont

4Northern Virginia Gastroenterology Associates, INOVA, Fairfax, Virginia

5Children's Hospital at Oklahoma University Medical Center, Oklahoma City, Oklahoma

6Pediatric Gastroenterology, Children's Hospital and Research Center, Oakland, California

7Department of Pediatrics, University of Nevada School of Medicine, Vegas, Nevada

8Department of Pediatric Gastroenterology, Loyola University Stritch School of Medicine, Chicago, Illinois

9Children's Hospital of Atlanta, Atlanta, Georgia

10Division of Pediatric Gastroenterology, Nemours Children's Clinics, Wilmington, Delaware

11Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

12Division of Pediatric Gastroenterology and Nutrition, Barbara Bush Children's Hospital, Portland, Maine

13University of Texas Southwestern Medical Center and Children's Medical Center of Dallas, Dallas, Texas

14University of Wisconsin, Madison, Wisconsin

15Center for Health Policy and Clinical Effectiveness, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

Reprints: Nationwide Children's Hospital, Ohio State University College of Medicine, Division of Pediatric Gastroenterology, Hepatology and Nutrition, 700 Children's Dr., Columbus Ohio 43205

Email: Wallace.crandall@nationwidechildrens.org

Received 30 April 2010; Accepted 19 May 2010

Grant sponsor: Centers for Education and Research in Therapeutics of the US Agency for Health Care Quality and Research; Grant Number: U18HS016957.

© Crohn's & Colitis Foundation of America, Inc.
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