L Gonczi1; Z Kurti*1; J Reinglas2; S Restellini2; S Nene2; R Kohen2; W Afif2; T Bessissow2; G Wild2; E Seidman2; A Bitton2; P Lakatos1,2
1. Semmelweis University, First Department of Medicine, Budapest, Hungary
2. Mcgill University Health Center, Department of Gastroenterology, Montreal, Canada
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.
We retrospectively analysed the quality of care IBD patients were receiving before and after their referral to MUHC IBD specialist and establishing the MUHC IBD centre. Consecutive patients were included with an outpatient visit (‘index visit’) at the MUHC IBD Centre from July 2016 to December 2016.
In total, 1357 patients 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. 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.
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.
Doctoral School: Clinical Medicine
Program: 2/15 Molecular Genetics, Pathomechanism and Clinical Aspects of Metabolic Disorders
Supervisor: Peter L. Lakatos
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