Simple Changes Improve Patient Care Across 26 Sites

Marcia Frellick

January 29, 2020

AUSTIN, Texas — Small changes in urgent care led to significant improvements in key quality indicators of care for patients with inflammatory bowel disease (IBD), findings from the IBD Qorus initiative show.

Multiple studies have revealed that the quality of care that patients with IBD receive around the country varies, said Gil Melmed, MD, director of clinical inflammatory bowel disease at Cedars-Sinai Medical Center in Los Angeles.

The IBD Qorus initiative was developed to look at the factors driving these differences and the changes that would have the most impact on access, care delivery, and patient education and satisfaction, he explained here at the Crohn's and Colitis Congress 2020.

A panel came up with 19 measures that could drive change, using the Breakthrough Series collaborative approach that was developed by the Institute for Healthcare Improvement to enhance care for adults with IBD.

These included slotting urgent-care time into daily schedules, setting up nursing hotlines, having teams review high-risk patients on a weekly basis, and having nurses make proactive calls to those patients.

Other measures included educating patients on when and how to seek urgent care and holding morning meetings to identify ways that the previous day's emergency department visits could have been prevented.

Qorus conducted in-person meetings and monthly webinars to share techniques with all members at the 26 participating sites — a mix of academic facilities and community and private practices — while each site tested one or more of the measures.

From January 2018 to April 2019, data were collected on 20,382 discrete patient visits, 58% involved Crohn's disease, 39% involved ulcerative colitis, and 3% involved other diseases.

The initiative identified seven measures that brought about improvement that was not random.

Table. Collaborative-Wide Improvements in Key Measures
Measure Baseline, % Final, % Relative Change, %
Perceived need for urgent care in the previous 6 months 0.26 0.21 –0.19
Emergency department use 0.18 0.14 –0.22
Hospitalization 0.14 0.11 –0.21
CT scan use 0.22 0.18 –0.18
Corticosteroid use 0.14 0.10 –0.29
Narcotic use 0.08 0.04 –0.50
Proportion of patients with high-risk status 0.14 0.06 –0.57

Such improvements would likely result in widespread cost savings over large populations, Melmed said.

One of the participating sites, University of Chicago Medicine, chose to focus on identifying high-risk patients and keeping the list updated and distributed, said Victoria Rai, clinical research coordinator at that site.

High-risk patients included frequent visitors to the emergency department, patients historically noncompliant with medications, and patients who recently presented with acute disease, she told Medscape Medical News. These patients were contacted by phone or through the patient portal by a designated core team.

Her site also set up bimonthly meetings so the team could make adjustments.

The changes have reduced visits to the emergency department and increased remission rates, Rai reported.

Small Investments, Big Improvements

IBD Qorus is an initiative of the Crohn's and Colitis Foundation. "Qorus is a great collaboration, among many different centers, that lets us see how we can make improvements in quality of care in the real-world setting with the barriers in everyday practice," said Benjamin Cohen, MD, from Mount Sinai in New York City, who was not involved with the initiative.

The data show that simple things can make a big difference, he told Medscape Medical News. A small investment, like adding a phone line to increase access to care, can lead to major improvement, and can be done easily.

Evidence from the large cohort can make the case that the investment is worth it. "They have a very powerful cohort. Hopefully we can all apply the lessons they teach us," Cohen said.

Crohn's and Colitis Congress (CCC) 2020. Presented January 25, 2020.

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