Quality improvement in inflammatory bowel disease

Abstract

Health services research suggests that health care could perform a great deal better than it does today. Improving the care of patients requires more than knowledge; achievement of improvements requires the application of the principles of continuous quality improvement. One of the barriers to quality improvement is unnecessary variation in care. Unnecessary variation, which erodes quality and reliability and adds to costs, is derived in part from habitual differences in practice style that are not grounded in knowledge or reason. Quality improvement efforts can reduce unnecessary variation. To attain continuous quality improvement in health care, it is necessary to repeatedly measure the processes and outcomes of care and design, implement interventions to improve the processes of care, and re-measure to determine the effect of the interventions. The road map of translational research begins with basic biomedical science and advances to clinical efficacy knowledge, to clinical effectiveness knowledge and finally to improved healthcare quality and value. Measurement and accountability of healthcare quality and cost, implementation of interventions, and healthcare system redesign, and scaling and spread of effective interventions are necessary to transform the healthcare system. In this chapter, we present an introduction to quality improvement and how it has been applied to pediatric inflammatory bowel disease, with brief discussions of variation in care, the Chronic Illness Care Model, the need for quality improvement, the Improvement Model, the improvement collaborative, the ImproveCareNow Network, Learning Health Systems, maintaining improvement, and improvement science in the business of health care.