Advances in translational science
Translating Improved Quality of Care Into an Improved Quality of Life for Patients With Inflammatory Bowel Disease

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The term quality of care has been interpreted in different ways in medicine. Skeptics of the quality movement insist that checkboxes and government and payer oversight will not lead to better patient outcomes. Supporters refer to areas in medicine in which quality improvement efforts have led to improved survival, such as in cystic fibrosis and cardiovascular disease. For quality improvement to be effective, the process demands rigorous documentation, analysis, feedback, and behavioral change. This requires valid metrics and mechanisms to provide dynamic point-of-care (or close to point of care) feedback in a manner that drives improvement. For inflammatory bowel disease, work has been performed in Europe and the United States to develop a framework for how practitioners can improve quality of care. Improve Care Now has created a sophisticated quality improvement program for pediatric patients with inflammatory bowel disease. The American Gastroenterology Association has worked within the National Quality Strategy framework to develop quality measures for patients with inflammatory bowel disease that have been incorporated into Federal programs that are moving Medicare reimbursement from a volume-based to a value-based structure. The Crohn's and Colitis Foundation of America is initiating a quality intervention program that can be implemented in community and academic practices to stimulate continual improvement processes for patients with inflammatory bowel disease. All of this work is intended to make quality improvement programs both feasible and useful, with the ultimate goal of improving quality of life for our patients.

Section snippets

What Has Been Done for Quality of Care in Inflammatory Bowel Disease?

Over the past decade, efforts to improve quality of care in IBD patients have appeared in many regions of the world. After an audit in 2006 showed widespread variation in care of patients with IBD in the United Kingdom, a multidisciplinary panel developed a set of IBD Standards that defined key performance indicators and guidelines for quality care. Although these standards are not all based on firm (high-quality) evidence, they do reflect a general multidisciplinary consensus on what defines

Why Is This Important and How Can This Be Incorporated Into Routine Clinical Practice?

Although the CCFA measures could be used in the office as a checklist of good quality of IBD care, their importance is to serve as the foundation on which to build a quality improvement program. CCFA plans to create an affordable and practical program that can be instituted at GI practices across the country. A pilot study currently is underway, with the quality improvement leaders at the CCFA receiving consultation from the leaders of the Improve Care Now network. This small-scale study will

What Are the Roadblocks and/or Limitations?

The efforts to improve quality of care for IBD are not without hurdles. The Improve Care Now network has been very successful in recruiting patients and enthusiastic collaborators, and developing an impressive infrastructure, but has struggled to keep costs affordable and funding sustainable. The AGA has created practical programs to help providers maintain gastroenterology certification and recognition for providing a high level of quality and incentive programs for both commercial payers and

Conclusions

The concept that measuring physicians' care delivery will improve individual patient's health outcomes, enhance the health of a population of patients, and bend the cost curve of health care delivery (the Triple Aim) is not new. What is new is the firm commitment from all payers that our reimbursement will be linked directly to performance measurement and health outcomes in the near future. From the CMS Value Based Payment Modifier program (set to launch in 2016) to the multiple commercial

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Conflicts of interest The authors disclose the following: Dr Siegel serves as a consultant for Abbvie, Elan, Janssen, Millenium, Given Imaging, UCB, and Prometheus; he has delivered Continuing Medical Education lectures for Abbvie and Janssen, and has received research support from Abbvie and Janssen; and he is currently the Chair of the Crohn's and Colitis Foundation of America Quality of Care Committee; Dr Allen is a member of the Crohn's and Colitis Foundation of America Quality Improvement Task Force, the American Gastroenterological Association Digestive Health Outcomes Registry Board, and is on the American Gastroenterological Association Governing Board and is the American Gastroenterological Association Vice President; Dr Melmed serves as a consultant to Abbvie, Amgen, Celgene, Given Imaging, and Jannsen; he has been a non-CME speaker for Abbvie and Prometheus, has received research funding from Pfizer; and is currently the co-chair of the Crohn's and Colitis Foundation of America Quality of Care Committee.

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