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
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.