Improved Outcomes in a Quality Improvement Collaborative for Pediatric Inflammatory Bowel Disease
Improved Outcomes in a Quality Improvement Collaborative for Pediatric Inflammatory Bowel Disease
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DOI：
10.1542/peds.2011-1700
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发表时间：
2012-04-01
期刊：
影响因子：
8
通讯作者：
Colletti, Richard B.
中科院分区：
文献类型：
--
作者：
Crandall, Wallace V.;Margolis, Peter A.;Colletti, Richard B.
目的：克罗恩病（CD）和溃疡性结肠炎（UC）患者的护理中的意外变化可能会阻止实现最佳结局。我们试图通过使用基于网络的质量改进methods.METHODS：通过使用修改后的突破系列协作结构，6 ImproveCareNow网络护理中心测试慢性病护理的变化，并每月收集数据，以改善慢性病护理和儿童炎症性肠病的结果。我们使用中断时间序列设计来评估这些变化的影响。结果：843名CD儿童和345名UC儿童的数据可用。护理服务的变化与完成疾病分类的就诊比例增加、开始使用硫嘌呤前测量硫嘌呤甲基转移酶（TPMT）以及接受适合其TPMT状态的初始硫嘌呤剂量的患者相关。除了CD患者的TPMT测量值（P = 0.12）外，所有过程变量在两个人群中均具有显著性（P <0.01）。非活动性疾病的CD（55%-68%）和UC（61%-72%）患者比例显著增加。未服用强的松的CD患者比例也显著增加（86%-90%）。参与中心不同的成功实现这些changes.CONCLUSIONS：改善CD和UC患者的结果与改善慢性病护理的过程中。变化的成功实施变革的重要性，克服组织因素有关的质量改进的成功。儿科2012; 129：e1030-e1041
OBJECTIVES: Unintended variation in the care of patients with Crohn disease (CD) and ulcerative colitis (UC) may prevent achievement of optimal outcomes. We sought to improve chronic care delivery and outcomes for children with inflammatory bowel disease by using network-based quality improvement methods.METHODS: By using a modified Breakthrough Series collaborative structure, 6 ImproveCareNow Network care centers tested changes in chronic illness care and collected data monthly. We used an interrupted time series design to evaluate the impact of these changes.RESULTS: Data were available for 843 children with CD and 345 with UC. Changes in care delivery were associated with an increase in the proportion of visits with complete disease classification, measurement of thiopurine methyltransferase (TPMT) before initiation of thiopurines, and patients receiving an initial thiopurine dose appropriate to their TPMT status. These were significant in both populations for all process variables (P < .01) except for measurement of TPMT in CD patients (P = .12). There were significant increases in the proportion of CD (55%-68%) and UC (61%-72%) patients with inactive disease. There was also a significant increase in the proportion of CD patients not taking prednisone (86%-90%). Participating centers varied in the success of achieving these changes.CONCLUSIONS: Improvements in the outcomes of patients with CD and UC were associated with improvements in the process of chronic illness care. Variation in the success of implementing changes suggests the importance of overcoming organizational factors related to quality improvement success. Pediatrics 2012; 129: e1030-e1041