P155 Adherence to quality indicators among patients with inflammatory bowel disease: an international comparative analysis

Abstract

Background: Deficiencies in quality of care have been identified in a variety of inflammatory bowel disease (IBD) care domains, such as appropriate use of steroid sparing agents and preventative health maintenance measures. Many of these differences are due to practice variations among providers. The aim of this study was to assess variations in adherence to IBD-specific quality indicators across two tertiary referral centres. Methods: A retrospective chart review measuring inpatient and outpatient quality indicators was conducted at Mount Sinai Hospital, Toronto, Canada (MSH) and the University of Leuven, Leuven, Belgium (UZL). The data were summarised using descriptive statistics and differences in quality indicators were assessed using the Fischer's exact test. A p-value of <0.05 was considered significant. Results: Among 450 outpatients (MSH = 225, UZL = 225), 269 (59.8%) had CD, 169 (37.7%) had UC, and 12 (2.7%) had IBD-U. All patients at UZL had undergone a post-operative colonoscopy to assess for recurrent disease within 12 months of surgery, when compared with 78% of patients at MSH (p < 0.001). More patients at MSH had been on a prolonged course of steroids, defined as a period of greater than 3 months (57.4% vs. 6.4%, p < 0.001), however no differences were seen in the use of steroid sparing therapy between the two sites. More patients at MSH underwent routine bone density screening (12.2 vs. 4.4%, p = 0.003). However, there were no significant difference in screening rates among patients who had been on a prolonged course of steroid (17.09 vs. 28.57%, p = 0.287). Dysplasia surveillance according to recommended intervals was more commonly performed at MSH (83.5 vs. 64.8%, p < 0.010). Flu and pneumococcal vaccinations were more often recommended at UZL (80.5 vs. 53.7% MSH, p < 0.001). Among 352 inpatients (MSH = 194, UZL = 158), more patients at MSH received DVT prophylaxis (86.1 vs. 31.7%, p < 0.001) and underwent C. difficile testing (70.1 vs. 57.6%, p = 0.015). There was no significant variation in initiation of salvage therapy after 7 days of IV steroids among inpatients with acute, severe UC (75.68 vs. 58.33%, p = 0.170). Conclusions: There were important differences in adherence to many of the quality indicators across two IBD referral centres. These differences underscore the notion that practice variations exist in managing complex IBD patients, even at IBD centres of excellence. Moreover, the regional variations noted underscore the importance of adapting quality improvement initiatives to the local context.