Search in the Abstract Database

Abstracts Search 2019

P633 Harmonisation of quality of care in an IBD centre impacts disease outcomes: importance of structure and process indicators

J. Reinglas*1, S. Restellini2, L. Gonczi3, Z. Kurti3, S. Nene1, R. Kohen1, W. Afif1, T. Bessissow1, G. Wild1, E. Seidman1, A. Bitton1, P. Lakatos1

1McGill University Health Center, Division of Gastroenterology, Montreal, Canada, 2Geneva’s University Hospitals and University of Geneva, Division of Gastroenterology and Hepatology, Geneva, Switzerland, 3Semmelweis University, First Department of Internal Medicine, Budapest, Hungary

Background

Optimal management of IBD requires harmonised monitoring and treatment pathways. We aimed to evaluate the quality of care at the McGill University Health Center (MUHC) IBD Center using quality of care indicators (QIs) including patient assessment strategy, monitoring, treatment decisions, and outcomes.

Methods

The MUHC IBD centre was officially established in July 2016 with a structure based on the PACE (Promoting Access and Care through Centers of Excellence) program developed by the Crohn’s and Colitis Canada organisation. We retrospectively analysed the quality of care IBD patients were receiving before and after their referral to MUHC IBD specialists and up until their first visit at the newly established MUHC IBD centre. Consecutive patients were included with an outpatient visit (‘index visit’) at the MUHC IBD Centre from July 2016 to December 2016. Demographic variables, outpatient visits, inpatient stays including IBD-related surgery, laboratory, imaging, and endoscopy data, current medications and/or changes in medications, and vaccination profiles were captured.

Results

In total, 1357 patients (64.4% Crohn’s disease (CD)) were included. At referral, a large proportion of patients were objectively re-evaluated (ileocolonoscopy: 79%, cross-sectional imaging: 15.6% of CD patients had abdomino-pelvic MRI or CT and 23.6% abdominal US, biomarkers CBC, CRP and FCAL: 89.9%, 81.9% and 16.5%, respectively). Therapeutic strategy was changed in 53.6% with 22.5% of patients starting biologics. Tight objective patient monitoring was applied also during follow-up (colonoscopy: 79%, cross-sectional imaging: 61.8% within 2 years prior to the index visit). Additional colonoscopy and imaging to evaluate disease activity was ordered in 32% and 19% within 6 months after the index visit. The frequency of therapeutic drug monitoring (TDM) was escalated following the establishment of the IBD centre. Maximum therapeutic step was accelerated with 48.8% of patients on biological therapy at the time of index visit. Treatment was changed in 17.8% of patients (active disease: 40.3%, patients in remission: 7.2%, p < 0.01). The need for surgery (4.3%) and hospitalisation (7.6%) were relatively low, while 16.8% of patients needed an IBD-related ER visit within 6 months after index visit.

Conclusion

Our data support that tight monitoring was applied at the MUHC IBD centre with a high emphasis on objective patient (re)evaluation, timely access and accelerated treatment strategy at referral or during follow-up. QIs mapped in this study can serve as reference data for comparison on structure, process algorithms and outcomes for IBD centres worldwide.