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Kappelman M, Margolis P, Moyer M, Cohen S, Gold B, Crandall W, Patel A, Mehta D, Milov D, Grunow J, Leibowitz I, Colletti R. The quality of care in pediatric inflammatory bowel disease: does the chronic care model work? J Pediatr Gastroenterol Nutr 2007;45:e5
1. University of North Carolina, Chapel Hill, NC, USA.
2. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
3. Children's Hospital of Atlanta, Atlanta, GA, USA.
4. Columbus Children's Hospital, Columbus, OH, USA.
5. Children's Medical Center of Dallas, Dallas, TX, USA.
6. Nemours Children's Clinics, Orlando, FL, USA.
7. Oklahoma University Medical Center, Oklahoma City, OK, USA.
8. Inova Health Systems, Fairfax, VA, USA.
9. University of Vermont, Burlington, VT, USA.
Background: Differences in health care delivery systems can cause variation in the process and quality of care.
Aims: 1) To quantify inter-center variation in the performance of recommended practices in pediatric inflammatory bowel disease (IBD). 2) To identify factors of health care delivery related to center performance.
Hypothesis: Elements of the Chronic Care Model, (community resources, health care organization, self-management support, delivery system design, decision support and clinical information systems) are positively associated with performance.
Methods: Using evidence and group consensus, the PIBDNet Trailblazer Improvement Collaborative developed recommended practices for Pediatric IBD care. Each of 7 centers performed a baseline chart audit on enrolled patients, recording the number of recommended practices that were performed. Centers also completed the Assessment of Chronic Illness Care (ACIC) survey, a validated instrument to assess the 6 elements of the Chronic Care Model.
Results: A mean of 17 charts (range 13-20) were audited at each center. Overall, 62% (44% to 97%) of recommended practices were performed. The mean ACIC score was 4.0 out of 11 (range 2.0 to 6.7), indicating basic chronic illness care. Centers scoring higher had better performance of recommended practices (Spearman correlation r=0.79, p=0.04).
Conclusions: Centers vary in their performance of recommended IBD practices. Performance is associated with the process of chronic illness care delivery. Opportunities exist to improve the quality of care and systems of care delivery in pediatric IBD.