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A Quality Improvement Approach to External Infliximab Infusions in Pediatric Inflammatory Bowel Disease

Gupta, Shivani R.; Crandall, Wallace V.; Donegan, Amy; Johnson, Marci; Drobnic, Barbara; Oates, Melanie; Boyle, Brendan; Maltz, Ross; Dotson, Jennifer L.*,†

Journal of Pediatric Gastroenterology and Nutrition: June 18, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002422
Original Article: Gastroenterology: PDF Only

Objectives: We used a quality improvement (QI) approach to improve access and reduce barriers to care by increasing the number of external infliximab infusions at our pediatric inflammatory bowel disease (IBD) center.

Methods: Using an iterative QI strategy, pediatric patients ≥12 years of age with IBD were offered the opportunity to receive infliximab infusions at home/an external infusion center. They were required to first have >5 infusions at the hospital without any significant infusion reactions. Data was collected and tracked monthly using p-charts. Comparisons between control chart centerlines were analyzed using the Fisher's Exact Test.

Results: Fifty-four patients received external infusions, 87% had Crohn's disease, 63% male, average age 17.6 ± 2.9 years, and 89% with private insurance. From September 2016 to January 2018, the percentage of eligible patients receiving external infusions was approximately 7%, increasing to nearly 30% by January 2018. A centerline shift, representing a statistically significant change, occurred in October 2016 and June 2017 (p < 0.001). No serious safety concerns have occurred.

Conclusions: Through a multidisciplinary team of stakeholders using QI strategies, we now offer external infusion service options to all appropriate patients as routine practice. Home infusions are a viable option to reduce barriers to care, and our patients did not experience any safety events.

*Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH

The Center for Innovation in Pediatric Practice, The Research Institute, Nationwide Children's Hospital, Columbus, OH.

Address correspondence and reprint requests to Jennifer L. Dotson, MD, MPH, Nationwide Children's Hospital, 700 Children's Drive Columbus, OH 43205 (e-mail:

Received 22 October, 2018

Accepted 13 April, 2019

Conflict of Interest and Sources of Funding: The authors have no conflicts of interest to declare pertaining to this manuscript. This work was not supported by grant funding.

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© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,