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

Abstract

Inflammatory bowel disease (IBD) is a lifelong, progressive disease that has disabling impacts on patient’s lives. Given the complex nature of the diagnosis of IBD and its management there is consequently a large economic burden seen across all health care systems. Quality indicators (QI) have been created to assess the different façades of disease management including structure, process and outcome components. Their development serves to provide a means to target and measure quality of care (QoC). Multiple different QI sets have been published in IBD, but all serve the same purpose of trying to achieve a standard of care that can be attained on a national and international level, since there is still a major variation in clinical practice. There have been many recent innovative developments that aim to improve QoC in IBD including telemedicine, home biomarker assessment and rapid access clinics. These are some of the novel advancements that have been shown to have great potential at improving QoC, while offloading some of the burden that IBD can have vis-a-vis emergency room visits and hospital admissions. The aim of the current review is to summarize and discuss available QI sets and recent developments in IBD care including telemedicine, and to give insight into how the utilization of these tools could benefit the QoC of IBD patients. Additionally, a treating-to-target structure as well as evidence surrounding aggressive management directed at tighter disease control will be presented.

Keywords: Inflammatory bowel disease; Telemedicine; Quality indicators; Quality of care; Treat-to-target

Core tip: The approach to diagnosis, follow up and management of inflammatory bowel disease (IBD) has undergone a major transformation in the past decade. Many different international quality indicators that span structure, process and outcome measures have been developed. These serve as major targets in optimizing quality of care (QoC). New developments have been designed to improve QoC including utilizing telemedicine, home biomarker testing and providing rapid access care to patients. Treating to target with proactive disease management guided by clinical history utilizing adjunctive biomarkers at the onset of IBD has been shown to improve objective outcomes. This will likely serve as the new favored treatment approach in many IBD centers across the globe.