Quality indicators for inflammatory bowel disease

Development of process and outcome measures

Gil Y. Melmed, Corey Allan Siegel, Brennan M. Spiegel, John I. Allen, Robert Cima, Jean Frederic Colombel, Themistocles Dassopoulos, Lee A. Denson, Sharon Dudley-Brown, Andrew Garb, Stephen B. Hanauer, Michael D. Kappelman, James D. Lewis, Isabelle Lynch, Amy Moynihan, David T. Rubin, R. Balfour Sartor, Ronald M. Schwartz, Douglas C. Wolf, Thomas A. Ullman

Research output: Contribution to journalReview article

80 Citations (Scopus)

Abstract

Introduction: Variation in adherence to management guidelines for inflammatory bowel disease (IBD) suggests variable quality of care. Quality indicators (QIs) can be developed to measure the structure, processes, and outcomes of health care delivery. The RAND/UCLA appropriateness method was used to develop a set of process and outcome QIs to define quality of care for IBD. Methods: Guidelines and position papers for IBD published from 2006 to 2011 were reviewed for potential QIs, which were rated by a multidisciplinary panel. Potential process and outcome QIs were discussed at 3 moderated in-person meetings, with pre-meeting and post-meeting confidential electronic voting. Panelists rated the validity and feasibility of QIs on a 1 through 9 scale; disagreement was assessed using a validated index. QIs rated above 8 were selected for the final set. Results: More than 500 potential process QIs were extracted from guidelines. Following ratings and discussion by the first panel, 35 process QIs were selected for literature review. After the second panel, 10 process QIs were included in the final set. Candidate outcome QIs were then derived from physician, nurse, and patient input and ratings, in addition to outcomes associated with candidate process QIs. None of the top QIs exhibited disagreement. Conclusions: A set of QIs for IBD was developed with expert interpretation of the literature and multidisciplinary input. Outcome QIs focused largely on remission and quality of life, whereas process QIs were aimed at therapeutic optimization and patient safety. Evaluation of these QIs in clinical practice is needed to assess the correlation of performance on process QIs with performance on outcome QIs.

Original languageEnglish (US)
Pages (from-to)662-668
Number of pages7
JournalInflammatory Bowel Diseases
Volume19
Issue number3
DOIs
StatePublished - Mar 1 2013
Externally publishedYes

Fingerprint

Process Assessment (Health Care)
Inflammatory Bowel Diseases
Outcome Assessment (Health Care)
Quality of Health Care
Guidelines
Politics
Patient Safety
Nurses
Quality of Life
Delivery of Health Care
Physicians
Therapeutics

Keywords

  • Crohn's disease
  • Inflammatory bowel disease
  • Quality
  • Quality indicators
  • Quality measures
  • Quality of care
  • Ulcerative colitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

Cite this

Quality indicators for inflammatory bowel disease : Development of process and outcome measures. / Melmed, Gil Y.; Siegel, Corey Allan; Spiegel, Brennan M.; Allen, John I.; Cima, Robert; Colombel, Jean Frederic; Dassopoulos, Themistocles; Denson, Lee A.; Dudley-Brown, Sharon; Garb, Andrew; Hanauer, Stephen B.; Kappelman, Michael D.; Lewis, James D.; Lynch, Isabelle; Moynihan, Amy; Rubin, David T.; Sartor, R. Balfour; Schwartz, Ronald M.; Wolf, Douglas C.; Ullman, Thomas A.

In: Inflammatory Bowel Diseases, Vol. 19, No. 3, 01.03.2013, p. 662-668.

Research output: Contribution to journalReview article

Melmed, GY, Siegel, CA, Spiegel, BM, Allen, JI, Cima, R, Colombel, JF, Dassopoulos, T, Denson, LA, Dudley-Brown, S, Garb, A, Hanauer, SB, Kappelman, MD, Lewis, JD, Lynch, I, Moynihan, A, Rubin, DT, Sartor, RB, Schwartz, RM, Wolf, DC & Ullman, TA 2013, 'Quality indicators for inflammatory bowel disease: Development of process and outcome measures', Inflammatory Bowel Diseases, vol. 19, no. 3, pp. 662-668. https://doi.org/10.1097/mib.0b013e31828278a2
Melmed, Gil Y. ; Siegel, Corey Allan ; Spiegel, Brennan M. ; Allen, John I. ; Cima, Robert ; Colombel, Jean Frederic ; Dassopoulos, Themistocles ; Denson, Lee A. ; Dudley-Brown, Sharon ; Garb, Andrew ; Hanauer, Stephen B. ; Kappelman, Michael D. ; Lewis, James D. ; Lynch, Isabelle ; Moynihan, Amy ; Rubin, David T. ; Sartor, R. Balfour ; Schwartz, Ronald M. ; Wolf, Douglas C. ; Ullman, Thomas A. / Quality indicators for inflammatory bowel disease : Development of process and outcome measures. In: Inflammatory Bowel Diseases. 2013 ; Vol. 19, No. 3. pp. 662-668.
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abstract = "Introduction: Variation in adherence to management guidelines for inflammatory bowel disease (IBD) suggests variable quality of care. Quality indicators (QIs) can be developed to measure the structure, processes, and outcomes of health care delivery. The RAND/UCLA appropriateness method was used to develop a set of process and outcome QIs to define quality of care for IBD. Methods: Guidelines and position papers for IBD published from 2006 to 2011 were reviewed for potential QIs, which were rated by a multidisciplinary panel. Potential process and outcome QIs were discussed at 3 moderated in-person meetings, with pre-meeting and post-meeting confidential electronic voting. Panelists rated the validity and feasibility of QIs on a 1 through 9 scale; disagreement was assessed using a validated index. QIs rated above 8 were selected for the final set. Results: More than 500 potential process QIs were extracted from guidelines. Following ratings and discussion by the first panel, 35 process QIs were selected for literature review. After the second panel, 10 process QIs were included in the final set. Candidate outcome QIs were then derived from physician, nurse, and patient input and ratings, in addition to outcomes associated with candidate process QIs. None of the top QIs exhibited disagreement. Conclusions: A set of QIs for IBD was developed with expert interpretation of the literature and multidisciplinary input. Outcome QIs focused largely on remission and quality of life, whereas process QIs were aimed at therapeutic optimization and patient safety. Evaluation of these QIs in clinical practice is needed to assess the correlation of performance on process QIs with performance on outcome QIs.",
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AU - Melmed, Gil Y.

AU - Siegel, Corey Allan

AU - Spiegel, Brennan M.

AU - Allen, John I.

AU - Cima, Robert

AU - Colombel, Jean Frederic

AU - Dassopoulos, Themistocles

AU - Denson, Lee A.

AU - Dudley-Brown, Sharon

AU - Garb, Andrew

AU - Hanauer, Stephen B.

AU - Kappelman, Michael D.

AU - Lewis, James D.

AU - Lynch, Isabelle

AU - Moynihan, Amy

AU - Rubin, David T.

AU - Sartor, R. Balfour

AU - Schwartz, Ronald M.

AU - Wolf, Douglas C.

AU - Ullman, Thomas A.

PY - 2013/3/1

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N2 - Introduction: Variation in adherence to management guidelines for inflammatory bowel disease (IBD) suggests variable quality of care. Quality indicators (QIs) can be developed to measure the structure, processes, and outcomes of health care delivery. The RAND/UCLA appropriateness method was used to develop a set of process and outcome QIs to define quality of care for IBD. Methods: Guidelines and position papers for IBD published from 2006 to 2011 were reviewed for potential QIs, which were rated by a multidisciplinary panel. Potential process and outcome QIs were discussed at 3 moderated in-person meetings, with pre-meeting and post-meeting confidential electronic voting. Panelists rated the validity and feasibility of QIs on a 1 through 9 scale; disagreement was assessed using a validated index. QIs rated above 8 were selected for the final set. Results: More than 500 potential process QIs were extracted from guidelines. Following ratings and discussion by the first panel, 35 process QIs were selected for literature review. After the second panel, 10 process QIs were included in the final set. Candidate outcome QIs were then derived from physician, nurse, and patient input and ratings, in addition to outcomes associated with candidate process QIs. None of the top QIs exhibited disagreement. Conclusions: A set of QIs for IBD was developed with expert interpretation of the literature and multidisciplinary input. Outcome QIs focused largely on remission and quality of life, whereas process QIs were aimed at therapeutic optimization and patient safety. Evaluation of these QIs in clinical practice is needed to assess the correlation of performance on process QIs with performance on outcome QIs.

AB - Introduction: Variation in adherence to management guidelines for inflammatory bowel disease (IBD) suggests variable quality of care. Quality indicators (QIs) can be developed to measure the structure, processes, and outcomes of health care delivery. The RAND/UCLA appropriateness method was used to develop a set of process and outcome QIs to define quality of care for IBD. Methods: Guidelines and position papers for IBD published from 2006 to 2011 were reviewed for potential QIs, which were rated by a multidisciplinary panel. Potential process and outcome QIs were discussed at 3 moderated in-person meetings, with pre-meeting and post-meeting confidential electronic voting. Panelists rated the validity and feasibility of QIs on a 1 through 9 scale; disagreement was assessed using a validated index. QIs rated above 8 were selected for the final set. Results: More than 500 potential process QIs were extracted from guidelines. Following ratings and discussion by the first panel, 35 process QIs were selected for literature review. After the second panel, 10 process QIs were included in the final set. Candidate outcome QIs were then derived from physician, nurse, and patient input and ratings, in addition to outcomes associated with candidate process QIs. None of the top QIs exhibited disagreement. Conclusions: A set of QIs for IBD was developed with expert interpretation of the literature and multidisciplinary input. Outcome QIs focused largely on remission and quality of life, whereas process QIs were aimed at therapeutic optimization and patient safety. Evaluation of these QIs in clinical practice is needed to assess the correlation of performance on process QIs with performance on outcome QIs.

KW - Crohn's disease

KW - Inflammatory bowel disease

KW - Quality

KW - Quality indicators

KW - Quality measures

KW - Quality of care

KW - Ulcerative colitis

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