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P155. Quality Improvement Tool: 3 year outcome

S. Chadokufa1, B. Huggett1, F. Kiparissi2, V. Evans2, K. Lindley2, N. Shah2, M. Mamoun Elawad2, N. Acton2, 1Great Ormond Street Hospital, Paediatric Gastroenterology, London, United Kingdom, 2Great Ormond Street Hospital, Gastro, London, United Kingdom

Background

ImproveCareNow (ICN) is an Quality Improvement (QI) Program established in 2007. ICN uses patient data to drive improvements in the care and health of IBD patients. It's a growing network of 57 international centres that benchmarks care against agreed targets: Clinical Remission and Steroid free remission and secondary targets of ensuring Adequate Nutrition and Growth, DiseaseClassification and Disease treatment. This is a report on 3 year experience of using the QI tool.

Methods

All eligible IBD patient enrolled in the program had their data collected at every clinic visitand were entered into an electronic database. Pre-visit planning meetings were held to discuss all patients prior to the clinic visit. The data that isentered consisted of diagnosis using the Paris classification, growth and nutrition, lab results, medications, physical assessments, disease activity and extra intestinal manifestation. Data from each visit was analysed and reports were generated within 24 hours. Weekly each patient's results were stratified and scored so that individual treatment plans could be instigated. The IBD team analyse the reports on a monthly basis and implement changes to clinical management on an individualized basis but adhering to local policy. Monthly QI meetings set and review 90 day Goals enabling the team to strive for better results. All ICN teams meet biannually to discuss QI tools. Out of 263 IBD patients, 242 (139 male/102 female, current mean age 12.98 y) were recruited into the database. 37 patients classified as early onset IBD were excluded.

Results

See Table 1.

Table 1
% of patients
Before 2011After 2013
Key measures
Remission rate60%76%
Steroid free remission rate50%71%
Off prednisone60%92%
With satisfactory nutritional status82%97%
At risk of nutritional failure9%3%
In nutritional failure9%0%
With satisfactory growth status92%96%
Service Figures
Number of IBD patientsNot known263
Number of clinics pre-visitedNone93%
Number of patients on steroidsUnknown10
% of complete data enteredn/a100%

Conclusion

ICN is an excellent tool of improving the quality of care of our patients, managing theirtreatment and improving their outcomes. By accurately collecting and monitoring data and benchmarking ourselves against set standards, measureable improvements have been achieved within standard medical treatment guidelines. Monitoring disease severity and having the ability to provide tailored treatment plans have been achieved, by using this quality improvement tool. IBD clinics have been streamlined, patient care has been standardised and key outcomemeasures have significantly improved. Overall ICN has enhanced the quality of life of our patients with IBD.