- Fecal Incontinence
|Selection of Quality Indicators in IBD: Integrating Physician and Patient Perspectives
Bitton A1, Vutcovici M1, Lytvyak E2, Kachan N3, Bressler B4, Jones J5, Lakatos PL1, Sewitch M1, El-Matary W6, Melmed G7, Nguyen G8; QI consensus group on behalf of the Promoting Access and Care through Centers of Excellence-PACE program. Inflamm Bowel Dis. 2018 Aug 29. doi: 10.1093/ibd/izy259. [Epub ahead of print]
1 Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada.
2 Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
3 Crohn's Colitis Canada.
4 Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
5 Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
6 Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.
7 Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
8 Mount Sinai Hospital, Center for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Canada.
BACKGROUND: Variation in clinical practice exists in many aspects of inflammatory bowel disease (IBD) care. Our aim was to develop a comprehensive set of quality indicators (QIs) to be measured in view of improving the quality of IBD care provided in clinical practice. This initiative was part of a global Canadian quality initiative PACE (Promoting Access and Care through Centres of Excellence).
METHODS: A modified RAND appropriateness method was used to identify and rate structure, process, outcome, and patient-derived QIs of IBD care. The process included a comprehensive literature search yielding a broad list of QIs, the online selection of QIs by a core expert panel, the selection of patient-derived QIs from 4 patient focus groups, and the subsequent selection of QIs by a multidisciplinary panel, followed by a moderated in-person multidisciplinary meeting during which each indicator was rated for importance and feasibility of measurement. Predetermined cutoffs for mean score and degree of disagreement were used to select the final list of QIs.
RESULTS: Forty-five QIs, including 6 that were patient-derived, were selected. Nine structure QIs addressed aspects related to the services and specialist care offered at an IBD unit or clinic. Thirty process indicators included administrative and workflow processes, features related to IBD therapy, surveillance, vaccination, and risk management. Six outcome QIs included measures of healthcare utilization, steroid use, and patient satisfaction.
CONCLUSIONS: Forty-five QIs including patient-derived indicators were selected through an iterative process. These indicators can be used to measure and improve the quality of care provided to IBD patients.