Monitoring Enables Progress: A Nationwide Quality Improvement Program in Children With Crohn Disease.
Journal
Journal of pediatric gastroenterology and nutrition
ISSN: 1536-4801
Titre abrégé: J Pediatr Gastroenterol Nutr
Pays: United States
ID NLM: 8211545
Informations de publication
Date de publication:
01 08 2021
01 08 2021
Historique:
pubmed:
31
3
2021
medline:
15
10
2021
entrez:
30
3
2021
Statut:
ppublish
Résumé
In this quality improvement program, named quality in pediatric inflammatory bowel disease, we constructed a nation-wide platform that prospectively recorded clinically important quality indicators in pediatric inflammatory bowel diseases (PIBD), aiming at improving clinical management across the country. Representatives of all 21 PIBD facilities in Israel formed a Delphi group to select quality indicators (process and outcomes), recorded prospectively over 2 years in children with Crohn's disease 2-18 years of age seen in the outpatient clinics. Monthly anonymized reports were distributed to all centers, allowing comparison and improvement. Trends were analyzed using the Mann-Kendall test, reporting τ (tau) values. The indicators of 3254 visits from 1709 patients were recorded from September 2017 to September 2019 (mean age 14.7 ± 3.1 years, median disease duration 1.8 years (interquartile range 0.69-4.02)). An increase in three of five process indicators was demonstrated: obtaining drug levels of anti-tumor necrosis factor (TNF) (τ = 0.4; P = 0.005), utilization of fecal calprotectin (τ = 0.38; P = 0.008) and bone density testing (τ = 0.45; P = 0.002). Among outcome indicators, three of nine improved as measured during the preceding year: calprotectin <300 μg/mg (τ = 0.35; P = 0.015), and "resolution of inflammation" defined as a composite of endoscopy, imaging and fecal calprotectin (τ = 0.39; P = 0.007). Endoscopic healing reached borderline significance (τ = 0.28; P = 0.055). An increase in the use of biologics throughout the study was observed (τ = 0.47; P = 0.001) with a concurrent decrease in the use of immunomodulators (τ = -0.47; P = 0.001). Quality improvement nationwide programs can be implemented with limited resources while facilitating standardization of care, and may be associated with improvements in measured indicators.
Identifiants
pubmed: 33783402
doi: 10.1097/MPG.0000000000003133
pii: 00005176-202108000-00020
doi:
Substances chimiques
Biomarkers
0
Leukocyte L1 Antigen Complex
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
236-241Informations de copyright
Copyright © 2021 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
Références
Wolters FL, Russel MGVM, Stockbrügger RW. Systematic review: has disease outcome in Crohn's disease changed during the last four decades? Aliment Pharmacol Ther 2004; 20:483–496.
Abreu MT, Sandborn WJ. Defining endpoints and biomarkers in inflammatory bowel disease: moving the needle through clinical trial design. Gastroenterology 2020; 159:2013.e73–2018.e73.
Crandall WV, Margolis PA, Kappelman MD, et al. Improved outcomes in a quality improvement collaborative for pediatric inflammatory bowel disease. Pediatrics 2012; 129:e1030–e1041.
Turner D, Carle A, Steiner SJ, et al. Quality items required for running a paediatric inflammatory bowel disease centre: an ECCO paper. J Crohns Colitis 2017; 11:981–987.
Chaudhuri S, Dutta D. Mann-Kendall trend of pollutants, temperature and humidity over an urban station of India with forecast verification using different ARIMA models. Environ Monit Assess 2014; 186:4719–4742.
Perla RJ, Provost LP, Murray SK. The run chart: a simple analytical tool for learning from variation in healthcare processes. BMJ Qual Saf 2011; 20:46–51.
Broide E, Shalem T. Israeli Society Pediatric Gastroenterology Hepatology And Nutrition, position paper: use of fecal calprotectin for the diagnosis of pediatric IBD. Published January 2019. [Accessed October 2020]
Shouval DS, Turner D, Assa A. [POSITION PAPER: ANTI-TNFα DRUG AND ANTI-DRUG MONITORING IN PEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE]. Harefuah. 2019;158:752–4. Hebrew.
Cholapranee A, Hazlewood GS, Kaplan GG, et al. Systematic review with meta-analysis: comparative efficacy of biologics for induction and maintenance of mucosal healing in Crohn's disease and ulcerative colitis controlled trials. Aliment Pharmacol Ther 2017; 45:1291–1302.
Colletti RB, Baldassano RN, Milov DE, et al. Variation in care in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 2009; 49:297–303.
Kappelman MD, Bousvaros A, Hyams J, et al. Intercenter variation in initial management of children with Crohn's disease. Inflamm Bowel Dis 2007; 13:890–895.
Krishnakumar C, Ballengee CR, Liu C, et al. Variation in care in the management of children with Crohn's disease: data from a multicenter inception cohort study. Inflamm Bowel Dis 2019; 25:1208–1217.
Pappa H, Thayu M, Sylvester F, et al. Skeletal health of children and adolescents with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2011; 53:11–25.
Ruemmele FM, Veres G, Kolho KL, et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. J Crohns Colitis 2014; 8:1179–1207.
Fiorino G, Lytras T, Younge L, et al. Quality of care standards in inflammatory bowel diseases: a European Crohn's and Colitis Organisation [ECCO] position paper. J Crohns Colitis 2020; 14:1037–1048.
Vande Casteele N, Ferrante M, Van Assche G, et al. Trough concentrations of infliximab guide dosing for patients with inflammatory bowel disease. Gastroenterology 2015; 148:1320–1329. e3.
Heida A, Park KT, van Rheenen PF, et al. Clinical utility of fecal calprotectin monitoring in asymptomatic patients with inflammatory bowel disease: a systematic review and practical guide. Inflamm Bowel Dis 2017; 23:894–902.
Turner D, Ricciuto A, Lewis A, et al. STRIDE-II: an update on the selecting therapeutic targets in inflammatory bowel disease (STRIDE) initiative of the International Organization for the Study of IBD (IOIBD): determining therapeutic goals for treat-to-target strategies in IBD. Gastroenterology 2021; In press.
Turner D, Griffiths AM, Walters TD, et al. Appraisal of the pediatric Crohn's disease activity index on four prospectively collected datasets: recommended cutoff values and clinimetric properties. Am J Gastroenterol 2010; 105:2085–2092.