Approaches to improve quality of care in inflammatory bowel diseases

Table 2 Crohn’s and Colitis Foundation of America inflammatory bowel disease process measures[17]

Process measures
Treatment
	If anti-TNF therapy is considered, then test for tuberculosis with skin testing or interferon gamma release assay
	If anti-TNF therapy is considered, then assess for latent hepatitis B virus
	Consider steroid sparing agent, if steroids needed at 10 mg (of more) daily for > 16 wk
	Test for Clostridium difficile if a patient presents with new symptoms of diarrhea
	If planning to start 6-mercaptopurine or azathioprine, then test for thiopurine methyltransferase and dose accordingly
	If a patient is hospitalized with severe colitis and does not improve after 3 d of IV steroids, flexible sigmoidoscopy with biopsies should be performed to check for CMV infection and surgery consulted
Surveillance
	If a patient with UC has low grade dysplasia in flat mucosa, then procto-colectomy or repeat surveillance in 6 mo should be offered
	If a patient has extensive UC or Crohn’s disease involving the colon for 8-10 yr, then surveillance colonoscopy should be performed every 1-3 yr
Health maintenance
	If a patient is on immunosuppressive therapy, then vaccinations for influenza and pneumococcus should be offered, as well as education regarding avoidance of live vaccines
	If a patient has Crohn’s disease, smoking status should be assessed and smoking cessation recommended

TNF: Tumor necrosis factor; UC: Ulcerative colitis.