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Kappelman MD, Cohen SA, Crandall W, Duffy LF, Gold BD, Grunow J, Kim SC, Leibowitz I, Margolis P, Mehta DI, Milov DE, Moyer MS, Myers SK, Patel AS, Schoen BT, Sudel B, Colletti RB. Accelerating improvement in the management of pediatric inflammatory bowel disease. Gastroenterol 2008;134(S1):A473
1. University of North Carolina, Chapel Hill, NC, USA.
2. Nationwide Children's Hospital, Columbus, OH, USA.
3. Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, USA.
4. University of Texas Southwestern, Dallas, TX, USA.
5. University of Oklahoma, Oklahoma City, OK, USA.
6. Nemours Children's Clinic , Orlando, FL, USA.
7. Inova Fairfax Hospital, Fairfax, VA, USA.
8. Children's Healthcare of Atlanta, Atlanta, GA, USA.
9. University of Minnesota, Mineapolis, MN, USA.
10. University of Vermont, Burlington, VT, USA.
Background: Recent reports indicate considerable variation in the management of pediatric inflammatory bowel disease(IBD). As with other chronic illnesses, quality improvement might faciliate the delivery of effective care and improve health outcomes. In children with IBD, growth and nutritional status are markers of disease activity and therapeutic effectiveness.
Objective: To determine whether participation in a multi-disciplinary improvement collaborative can increase the rates of growth and nutritional assessment in children with IBD.
Methods: In March 2007, 8 centers formed an IBD improvement collaborative (2 centers joined later). Centers attended 2 learning sessions and participated in monthly conference calls where they reviewed the evidence for recommended practices, were provided with decision support tools, and received training in quality improvement methods. Each center was encouraged to develop and test small changes related to the system of healthcare delivery, and to share and expand upon successful ones. The documentation of height, weight, and BMI and the classification of growth and nutritional status according to established definitions were recorded at each patient encounter, and monthly run charts were created to track performance improvement. Pre and post-intervention data were compared using Fisher's exact test.
Results: Over a 7 month period, participating centers enrolled a total of 1062 patients, comprising 1986 visits. The proportion of visits at which height, weight, and BMI were documented increased from 56% to 85% (p< 0.0001). Classification of growth and nutritional status at each visit increased from 57% to 86% (p< 0.0001) and from 56% to 86% (p< 0.0001) respectively.
Discussion: IBD quality improvement in pediatric gastroenterology practices is feasible and highly effective. We anticipate that increased awareness of growth and nutritional status will ultimately lead to improved patient outcomes.