Improved Outcomes in a Quality Improvement Collaborative for Pediatric Inflammatory Bowel Disease

Overview

Journal Pediatrics

Specialty Pediatrics

Date 2012 Mar 14

PMID 22412030

Citations 85

Authors

Wallace V Crandall

Peter A Margolis

Michael D Kappelman

Eileen C King

Jesse M Pratt

Brendan M Boyle

Lynn F Duffy

John E Grunow

Sandra C Kim

Ian Leibowitz

Bess T Schoen

Richard B Colletti

Affiliations

Soon will be listed here.

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.

Citing Articles

Using a collaborative learning health system approach to improve disease activity outcomes in children with juvenile idiopathic arthritis in the Pediatric Rheumatology Care and Outcomes Improvement Network.

Harris J, Bingham C, Vora S, Yildirim-Toruner C, Batthish M, Bullock D Front Pediatr. 2024; 12:1434074.

PMID: 39156025 PMC: 11327817. DOI: 10.3389/fped.2024.1434074.

Interventions to improve system-level coproduction in the Cystic Fibrosis Learning Network.

Gamel B, Albon D, Bandla S, Davison D, Flath J, Sabadosa K BMJ Open Qual. 2024; 13(3).

PMID: 39067867 PMC: 11287073. DOI: 10.1136/bmjoq-2024-002860.

Variation Between Hospitals in Outcomes and Costs of IBD Care: Results From the IBD Value Study.

van Linschoten R, van der Woude C, Visser E, van Leeuwen N, Bodelier A, Fitzpatrick C Inflamm Bowel Dis. 2024; 31(2):332-343.

PMID: 38666643 PMC: 11808576. DOI: 10.1093/ibd/izae095.

Building a regional pediatric asthma learning health system in support of optimal, equitable outcomes.

Beck A, Seid M, McDowell K, Udoko M, Cronin S, Makrozahopoulos D Learn Health Syst. 2024; 8(2):e10403.

PMID: 38633017 PMC: 11019385. DOI: 10.1002/lrh2.10403.

Testing an Automated Approach to Identify Variation in Outcomes among Children with Type 1 Diabetes across Multiple Sites.

Addison J, Razzaghi H, Bailey C, Dickinson K, Corathers S, Hartley D Pediatr Qual Saf. 2024; 7(5):e602.

PMID: 38584961 PMC: 10997286. DOI: 10.1097/pq9.0000000000000602.

References

Weiner B, Shortell S, Alexander J . Promoting clinical involvement in hospital quality improvement efforts: the effects of top management, board, and physician leadership. Health Serv Res. 1997; 32(4):491-510. PMC: 1070207. View

Turner D, Grossman A, Rosh J, Kugathasan S, Gilman A, Baldassano R . Methotrexate following unsuccessful thiopurine therapy in pediatric Crohn's disease. Am J Gastroenterol. 2007; 102(12):2804-12. DOI: 10.1111/j.1572-0241.2007.01474.x. View

Crandall W, Kappelman M, Colletti R, Leibowitz I, Grunow J, Ali S . ImproveCareNow: The development of a pediatric inflammatory bowel disease improvement network. Inflamm Bowel Dis. 2010; 17(1):450-7. DOI: 10.1002/ibd.21394. View

Mehrotra A, Pearson S, Coltin K, Kleinman K, Singer J, Rabson B . The response of physician groups to P4P incentives. Am J Manag Care. 2007; 13(5):249-55. View

Chin M . Quality improvement implementation and disparities: the case of the health disparities collaboratives. Med Care. 2010; 48(8):668-75. PMC: 3401560. DOI: 10.1097/MLR.0b013e3181e3585c. View

Boyle B, Mackner L, Ross C, Moses J, Kumar S, Crandall W . A single-center experience with methotrexate after thiopurine therapy in pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2010; 51(6):714-7. DOI: 10.1097/MPG.0b013e3181dd861a. View

Kaplan H, Lannon C, Walsh M, Donovan E . Ohio statewide quality-improvement collaborative to reduce late-onset sepsis in preterm infants. Pediatrics. 2011; 127(3):427-35. DOI: 10.1542/peds.2010-2141. View

Bodenheimer T, Wagner E, Grumbach K . Improving primary care for patients with chronic illness. JAMA. 2002; 288(14):1775-9. DOI: 10.1001/jama.288.14.1775. View

Bravata D, Gienger A, Holty J, Sundaram V, Khazeni N, Wise P . Quality improvement strategies for children with asthma: a systematic review. Arch Pediatr Adolesc Med. 2009; 163(6):572-81. DOI: 10.1001/archpediatrics.2009.63. View

10.

Kilo C . A framework for collaborative improvement: lessons from the Institute for Healthcare Improvement's Breakthrough Series. Qual Manag Health Care. 1999; 6(4):1-13. DOI: 10.1097/00019514-199806040-00001. View

11.

Marsteller J, Shortell S, Lin M, Mendel P, Dell E, Wang S . How do teams in quality improvement collaboratives interact?. Jt Comm J Qual Patient Saf. 2007; 33(5):267-76. DOI: 10.1016/s1553-7250(07)33031-6. View

12.

Hyams J, Crandall W, Kugathasan S, Griffiths A, Olson A, Johanns J . Induction and maintenance infliximab therapy for the treatment of moderate-to-severe Crohn's disease in children. Gastroenterology. 2007; 132(3):863-73. DOI: 10.1053/j.gastro.2006.12.003. View

13.

Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S . An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006; 355(26):2725-32. DOI: 10.1056/NEJMoa061115. View

14.

Bradley E, Holmboe E, Mattera J, Roumanis S, Radford M, Krumholz H . A qualitative study of increasing beta-blocker use after myocardial infarction: Why do some hospitals succeed?. JAMA. 2001; 285(20):2604-11. DOI: 10.1001/jama.285.20.2604. View

15.

Coleman K, Austin B, Brach C, Wagner E . Evidence on the Chronic Care Model in the new millennium. Health Aff (Millwood). 2009; 28(1):75-85. PMC: 5091929. DOI: 10.1377/hlthaff.28.1.75. View

16.

Mangione-Smith R, DeCristofaro A, Setodji C, Keesey J, Klein D, Adams J . The quality of ambulatory care delivered to children in the United States. N Engl J Med. 2007; 357(15):1515-23. DOI: 10.1056/NEJMsa064637. View

17.

Ovretveit J, Bate P, Cleary P, Cretin S, Gustafson D, McInnes K . Quality collaboratives: lessons from research. Qual Saf Health Care. 2002; 11(4):345-51. PMC: 1757995. DOI: 10.1136/qhc.11.4.345. View

18.

Miller M, Griswold M, Mitchell Harris 2nd J, Yenokyan G, Huskins W, Moss M . Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts. Pediatrics. 2010; 125(2):206-13. DOI: 10.1542/peds.2009-1382. View

19.

Wilson T, Berwick D, Cleary P . What do collaborative improvement projects do? Experience from seven countries. Jt Comm J Qual Saf. 2003; 29(2):85-93. DOI: 10.1016/s1549-3741(03)29011-0. View

20.

Benneyan J, Lloyd R, Plsek P . Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care. 2003; 12(6):458-64. PMC: 1758030. DOI: 10.1136/qhc.12.6.458. View