Interventions to Decrease Unplanned Healthcare Utilization and Improve Quality of Care in Adults With Inflammatory Bowel Disease: A Systematic Review

Clin Gastroenterol Hepatol. 2022 Sep;20(9):1947-1970.e7.doi: 10.1016/j.cgh.2021.08.048. Epub 2021 Sep 3.


David I Fudman 1Andrea Escala Perez-Reyes 2Blake A Niccum 3Gil Y Melmed 4Hamed Khalili 5


Author information

1Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: david.fudman@utsouthwestern.edu.

2Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.

3Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.

4Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, New York, New York.

5Division of Gastroenterology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.


Background & aims: Inflammatory bowel disease (IBD) care and outcomes exhibit substantial variability, suggesting quality gaps. We aimed to identify interventions to narrow these gaps.

Methods: We performed a systematic review of Medline, Embase, and Web of Science through May 2021 to find manuscripts and abstracts reporting quality improvement (QI) interventions in IBD. We included studies with interventions that addressed acute care utilization, vaccination, or Crohn's and Colitis Foundation quality indicators for care processes, including pre-therapy testing, tobacco cessation, colorectal cancer surveillance, Clostridium difficile infection screening in flares, sigmoidoscopy in patients hospitalized with ulcerative colitis, and use of steroid-sparing therapy. The primary objective was to identify successful QI interventions. Risk of bias assessment was conducted using the Joanna Briggs Institute critical appraisal checklist.

Results: Twenty-three manuscripts and 23 meeting abstracts met inclusion criteria. Influenza and pneumococcal vaccination were the most studied indicators (24 references), followed by emergency room and/or hospital utilization, tobacco cessation, and pre-therapy testing (17, 11, and 10 references, respectively). Electronic medical record-based interventions were the most frequent, whereas other initiatives used strategies that included changes to care structure or delivery, vaccination protocols, or physician and patient education. Successful interventions matched the complexity of the metric to the intervention including making changes to care structure or delivery, empowered non-physician staff, and used electronic medical record changes to prompt clinicians.

Conclusions: The quality of IBD care can be improved with diverse interventions that range from simple to complex. However, these interventions are not universally successful. Clinicians should emulate successful interventions and design new initiatives to narrow gaps in care quality.


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