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* = Presenting author

P259 Improvement of Patient's Disease Activity in Paediatric Inflammatory Disease (pIBD) after adoption of ImproveCareNow (ICN) Quality Improvement (QI) Tool

B. Huggett*1, S. Chadokufa1, S. Sider1, T. Sawney1, N. Shah1, M. Elawad1, F. Kiparissi1, 2

1Great Ormond Street Hospital, Paediatric Gastroenterology, London, United Kingdom, 2University College London Hospitals NHS Foundation Trust, Department of Gastroenterology, London, United Kingdom

Background

ImproveCareNow (ICN) a QI program benchmarking patient visit outcomes against currently 66 pIBD centres, monitoring 18 000 pIBD patients in a live database. Agreed outcomes include Clinical Remission, Steroid-free remission, Nutrition and Growth, Disease Classification and Treatment. We joined ICN in 2010, allowing us to look at our patient's outcomes. Our aim is to report improvements from adoption of ICN quality improvement tool benchmarking ourselves against agreed international standards.

Methods

270 IBD patients (P) (154 male, 0.4m-16years, median age at diagnosis 9.7y) were registered over a 4 year period. Data was collected prospectively with each clinic visit and entered into the database. This included diagnosis, nutrition, anthropometrics, Results, medication and physicians global assessment (PGA). The QI tool required pre-clinic planning meetings and Results were stratified allowing implementation of approved treatment plans. Monthly QI meetings set/review 90 day goals enabling service development. Results were stratified and discussed within weekly meetings, where individual treatment plans were initiated. Monthly QI meetings set and reviewed outcome goals.

Results

Over a 4year period the following outcome measures were achieved:

Overall remission rates increased from 46% to 78%,

Steroid-free remission increased from 60% to 92%,

Satisfactory nutritional status increased from 82% to 97%,

Satisfactory growth from 92% to 96%,

Nutritional failure decreased form 9% to zero,

Mild disease activity decreased from 23% to 16%,

Occurence of moderate to severe disease activity decreased from 31% to 6% and has been consistently below 10% over the last year.

Conclusion

By adopting the ICN standards and utilizing the QI tool, we achieved measurable improvement of pIBD outcomes, using accurate collection and monitoring of data (24-hourly updated reports) and benchmarking against set standards, allowing us timely intervention. Patient care was standardized. Overall ICN has dramatically improved patient outcomes.