Abstract:
OBJECTIVES:Unintended variation in the care of patients with Crohn disease (CD) and ulcerative colitis (UC) may prevent achievement of optimal outcomes. We sought to improve chronic care delivery and outcomes for children with inflammatory bowel disease by using network-based quality improvement methods. METHODS:By using a modified Breakthrough Series collaborative structure, 6 ImproveCareNow Network care centers tested changes in chronic illness care and collected data monthly. We used an interrupted time series design to evaluate the impact of these changes. RESULTS:Data were available for 843 children with CD and 345 with UC. Changes in care delivery were associated with an increase in the proportion of visits with complete disease classification, measurement of thiopurine methyltransferase (TPMT) before initiation of thiopurines, and patients receiving an initial thiopurine dose appropriate to their TPMT status. These were significant in both populations for all process variables (P < .01) except for measurement of TPMT in CD patients (P = .12). There were significant increases in the proportion of CD (55%-68%) and UC (61%-72%) patients with inactive disease. There was also a significant increase in the proportion of CD patients not taking prednisone (86%-90%). Participating centers varied in the success of achieving these changes. CONCLUSIONS:Improvements in the outcomes of patients with CD and UC were associated with improvements in the process of chronic illness care. Variation in the success of implementing changes suggests the importance of overcoming organizational factors related to quality improvement success.
journal_name
Pediatricsjournal_title
Pediatricsauthors
Crandall WV,Margolis PA,Kappelman MD,King EC,Pratt JM,Boyle BM,Duffy LF,Grunow JE,Kim SC,Leibowitz I,Schoen BT,Colletti RB,ImproveCareNow Collaborative.doi
10.1542/peds.2011-1700subject
Has Abstractpub_date
2012-04-01 00:00:00pages
e1030-41issue
4eissn
0031-4005issn
1098-4275pii
peds.2011-1700journal_volume
129pub_type
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