Quality of care in inflammatory bowel diseases: What is the best way to better outcomes?

Table 1 Available quality indicators-set to assess the quality of care in inflammatory bowel disease

	AGA	CCFA	PACE1	Spanish1	Asia
Structural QIs
IBD unit/clinic
Has access to healthcare professionals: pharmacist, ophthalmologist, rheumatologist, obstetrician and dermatologist			√
Has access to all of the following healthcare professionals: Dieticians, mental health worker/psychologist, stoma therapist			√
Has a dedicated IBD nurse.			√	√
Has at least one gastroenterologist with specialized IBD training			√
Has timely access to an Endoscopy Unit			√	√
Has access to CT and MRI with at least one modality with enterography			√	√
Has access to a GI radiologist and a GI histopathologist			√	√
Has access to a surgical program that performs at least 10 Ileoanal pouch operations a year			√
Has access to a fellowship trained colorectal surgeon			√	√
Should be integrated in a hospital with an Emergency Department			√	√
Process QIs
IBD type documented including disease location and severity	√	√	√		√
Latent tuberculosis and Hepatitis B testing before anti-TNF therapy	√	√	√	√	√
Appropriate initiation of steroid-sparing therapy	√	√	√	√	√
Clostridium difficile testing during acute flares	√	√	√	√	√
Venous thromboembolism prophylaxis is administered to patients according to national guidelines	√	√	√	√	√
Cytomegalovirus testing via flexible sigmoidoscopy in steroid-refractory UC		√	√	√
TPMT testing prior to thiopurine therapy		√	√
Colectomy or close surveillance for low-grade dysplasia		√	√	√
Surveillance colonoscopy for patients with colonic disease		√	√	√
Screening and counseling for smoking cessation	√	√	√	√	√
Vaccine education including pneumococcal and influenza	√	√	√	√	√
Each IBD patient should be assigned one identifiable IBD specialist in charge of their care			√	√
In patients with corticosteroid refractory IBD other induction therapies are recommended			√
Medical salvage therapy and surgery are offered in UC inpatients failing to respond to intravenous corticosteroids within 5 d			√
The IBD Unit/clinic has a mechanism to screen for mental health issues			√
Patients with IBD receiving maintenance immunosuppressive therapy are monitored with a blood count and liver profile every three months			√	√
Disease activity assessment is performed after initiating induction therapy			√
The IBD Unit/clinic has a formal process for transfer of care from pediatric to adult			√
IBD patients at risk for metabolic bone disease are assessed managed accordingly	√	√	√		√
Calcium and Vitamin D are recommended in conjunction with systemic corticosteroids			√
All HBsAg+ IBD patients should receive antiviral drugs while being treated with an anti-TNF drug			√	√
Outcomes QIs
Proportion of patients with steroid-free clinical remission (CR) for > 12-mo period		√	√
Proportion of patients currently taking prednisone (excluding those diagnosed within 112 d)		√
Number of days per month/year lost from school/work attributable to IBD		√
Number of days per year in the hospital attributable to IBD		√	√
Number of emergency room visits per year for IBD		√	√
Proportion of patients with malnutrition		√
Proportion of patients with anemia		√
Proportion of patients with normal disease-targeted health-related quality of life		√
Proportion of patients currently taking narcotic analgesics		√
Proportion of patients with nighttime BM’s or leakage		√
Proportion of patients with incontinence in the last month		√
Number of IBD-related surgeries per patient-year			√
Validated assessment of patient adherence to management plan			√

¹Only selected QIs included. AGA: American Gastrointestinal Association; CCFA: Crohn’s and Colitis Foundation of America; MRI: Magnetic resonance imaging; PACE: Promoting access and care through centers of excellence; QI: Quality indicators; IBD: Inflammatory bowel disease; CT: Computed tomography; GI: Gastrointestinal; UC: Ulcerative colitis.