ImproveCareNow is being highlighted by the Agency for Healthcare Research and Quality (AHRQ). AHRQ previously provided funding to help create enhancements of the ImproveCareNow registry, including automated population management, pre-visit planning, Quality Improvement performance and data quality reports. The efforts of physicians, improvers, parents and patients are also highlighted.

Perianal disease is an important complication of Crohn’s disease in children. In May at Digestive Diseases Week 2015, a meeting of nearly 15,000 gastroenterologists from around the world, Dr. Jeremy Adler (@jeremyadlermd) presented research investigating instances of perianal disease (perianal fistulas, fissures and other perianal lesions) in pediatric Crohn’s disease, using data from the ImproveCareNow pediatric IBD registry (known as “ICN2”).

Using data from ICN2, Adler’s research team identified racial and regional differences in the development of perianal disease across multiple centers in the ImproveCareNow Network. Their research has shed light on when perianal disease most commonly occurs (early in pediatric Crohn’s disease) and suggests that early therapy should be aimed at fistula prevention. They concluded that the ICN2 registry is a valuable tool for population-based studies (like this one, which included data from many patients with IBD, across many different geographic areas), and suggest that more studies like this one be conducted to identify and evaluate preventative therapies for complications of Inflammatory Bowel Disease (like perianal disease).

This novel pediatric IBD research highlights the power of data, carefully collected and curated over time, to answer questions about complex conditions such as Crohn’s disease and ulcerative colitis and to shine light on ways we can work to improve the care and the health of patients in the near term.

ICN2 is the largest and fastest growing pediatric IBD registry in the world, with data from over 19,000 patients with IBD and 115,000 visits as of May 2015. The ImproveCareNow Network currently includes 75 participating pediatric IBD centers in 34 states and the District of Columbia and two in England, with nearly 45% of Crohn’s disease and ulcerative colitis patients cared for by US pediatric gastroenterologists. The purpose of ImproveCareNow is to transform the health, care and costs for all children and adolescents with Crohn’s disease and ulcerative colitis by building a sustainable collaborative chronic care network, enabling patients, families, clinicians and researchers to work together in a learning health care system to accelerate innovation, discovery and the application of new knowledge. Data in the ImproveCareNow registry is used for improvement, research and innovation.

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Editor's note: The ImproveCareNow registry (ICN2) has grown dramatically over the past several years, and now, from the research standpoint, we are beginning to see the fruits of that labor. Jeremy Adler and colleagues have used the registry to carefully describe a specific phenotype of pediatric Crohn's disease across the network. We are only beginning to scratch the surface in utilizing not only the registry, but also the rich community network upon which ImproveCareNow is built. More and different types of research efforts are coming, and hopefully, the number of studies will continue to grow as quickly as the number of centers and patients have grown within the network.

There is an articulate and thoughtful patient engagement leader from the UK who I follow on twitter named David Gilbert. Like me, you may enjoy reading some of his reflections on the key role of patient leaders in improving care and health systems and think about the lessons for your own work in integrating patient and parent partners into your improvement teams. In ImproveCareNow, we share a lot of writing and reflections from those working as IBD advocates and improvers, but I personally learn a lot from the perspective of those working on very different issues (though it’s amazing how much improving care for IBD actually does have in common with improving care for other chronic conditions like mental illness and even patient safety issues!). David shared a quote that made me think about the recent growth of patient partnership we’ve seen right here on this side of the pond in ImproveCareNow:

“Knowing trees, I understand the meaning of patience. Knowing grass, I can appreciate persistence.”  (Hal Borland)

I recently wrote about early lessons learned in the ImproveCareNow Engagement and Leadership Campaign. We were feeling our way, helping a small group of centers figure out what it meant to grow their teams by including more parent and patient partners in planning, carrying out, and evaluating the impact of improvement and awareness activities. While only three months have passed, so much has happened. The ImproveCareNow Community met in March at our Community Conference and we enjoyed watching clinicians, parents, patients, and others work together to share and improve upon ideas for helping more kids with IBD get into remission and stay there.

But the other thing that has happened in this short time is that watching engagement and partnership grow in ICN has become a bit less like patiently watching trees and a bit more like marveling at the persistence of grass. I sat down last week to review ImproveCareNow centers’ monthly narrative reports (in which they share their activities, barriers, and lessons learned), as well as recent activity on social media. I was thrilled to see concrete steps toward partnership taking place at a number of centers that had not yet begun this journey just a few months ago. Here are just a few snippets of what we are seeing emerge:

From ICN Centers’ narrative reports:

“We have sought and received very positive feedback from our parent who attended the meeting and will begin working with her to plan how we can involve her more actively and engage other families.”

“We are meeting with a hospital rep on Friday to work on formalizing a parent group!”

“We had our first meeting with our parent partner!” 

“We had a meeting in April with our parent and will conduct monthly meetings with her.”

On our ICN Exchange

On Twitter

There is indeed still so much work to do. There are more than 70 care centers in ImproveCareNow and many are still contemplating how best to launch and navigate these new types of partnerships with patients and families. But what I find encouraging is that the stories of progress that are emerging are not concentrated in one type of ImproveCareNow center or in one Learning Lab or in the centers that are known for being quicker to adapt to change. And they are not all stories of one type of engagement…building a mentoring program with patients or inviting a parent to join a QI meeting or having parents complete a survey about areas for improvement. Centers, with their patients, are trying to identify their own specific needs and assets and craft partnership opportunities that build upon them. They realize that not every partner—and not every clinician for that matter—is ready to engage at the same level (be it awareness, participation, contribution, or ownership as described by some of my colleagues in JAMA last year.) And they realize that that’s OK.

Partnering in these new ways can be hard. To extend the “persistence of grass” analogy, sometimes things grow too quickly and we even see weeds emerge. It takes work to get through those patches and get back to things growing the way they should. Patient partners may not feel heard right away—may not feel like full partners. Clinicians may feel worried about sharing their clinic’s opportunities for improvement and may even feel that their expertise—their ideas—carry less weight. As someone who helps the different stakeholders in this system work together, I am the first to admit that it is not always easy and can indeed be scary: We step on toes. We use the wrong words. We don’t always give everyone equal “airtime.”  But it’s particularly encouraging to see members of this community openly discussing these concerns and barriers and helping each other come up with ideas for surmounting them.

Three months from now I fully expect we will have more progress to share and will continue to see the fruits of our patience over the years as we have watched this community grow.  I am eager to see community members share their stories on this blog and help us learn from and with them.

As a graduate student in a business school, I strive to apply what I’ve learned about management science to address problems of importance to society. So needless to say, working on research projects in partnership with the C3N Project and ImproveCareNow (ICN) has been educational and enlightening. Growth of the ImproveCareNow Network has brought both exciting opportunities and new practical challenges, as Sarah Myers discussed in her recent LOOP post. In the spirit of continuous improvement, ICN leaders wanted an enhanced, evidence-based understanding of Learning Labs and other models for collaboration at different levels of scale. And I was thrilled for the opportunity to support this effort.

Many of you will recall a survey distributed last summer by ImproveCareNow. The survey presented a series of questions with two scenarios for network-based group learning, asking respondents to choose the scenario which seemed most conducive to learning and improvement. Those paired scenarios appeared to be very similar; a few respondents even wrote to tell us that the survey was defective, presenting the same question over and over again! But, in fact we were using an advanced and efficient method, the discrete choice experiment (DCE), to collect feedback on strategies for continuous learning from within the network itself. Discrete choice methods – common in marketing research as well as health economics and policy studies – use experimental design to assess the relative importance that customers/end-users place on attributes of a given product, service, or scenario. For example, a DCE for the design of new laptop computers might examine factors such as weight, battery life, memory, and price. Comparison of patient treatment options with DCE might explore tradeoffs between efficacy, cost, and invasiveness.

Our DCE for ImproveCareNow evaluated three group learning techniques: micro-communities called “Learning Labs”, quality improvement curricula, and team-to-team mentoring. As a research team, we are extremely appreciative of the 149 survey respondents representing 63 ICN care centers. We had a response rate of 65%, increasing confidence that our results accurately represented network preferences.

Overall, we observed that ImproveCareNow participants preferred mixed Learning Labs (including both novice and experienced care teams) over cohorts of teams with similar levels of experience, sequential curriculum (introduction of topics in a structured succession) rather than a simultaneous overview of QI tools and interventions, and ad hoc mentoring based on focal topics rather than an assigned, permanent mentor team. We also observed interesting variation in preferences across subgroups based on individuals’ time in the network, professional roles, and characteristics of care centers such as patient population size. I am excited to share these results in greater detail – and most importantly, to discuss what we’ve learned with the ICN community – at the upcoming network-wide webinar on Tuesday May 12 (11 ET). Please join us to weigh in!

As improvement networks scale up, it is not enough to do more of the same in a bigger way… Understanding how to adapt structures for continuous learning as networks grow and change is necessary for development of learning health care systems. Engaging network participants to share their collective wisdom is essential for improving what ImproveCareNow does, and also for targeted improvements in costs, care, and outcomes.

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published by ImproveCareNow on behalf of Shannon Provost

Shannon M. Provost, MBA, is pursuing a PhD in Information, Risk, and Operations Management in the McCombs School of Business at the University of Texas at Austin and building a program of research around innovation ecosystems, social networks, and the science of improvement. She is also an Assistant Instructor of undergraduate business statistics. Shannon is grateful for learning opportunities which have emerged through her work as a visiting researcher at the James M. Anderson Center for Health Systems Excellence at Cincinnati Children’s Hospital Medical Center and as a member of the Institute for Healthcare Improvement faculty. Personal interests include travel, fashion, literature, beagles, and attempting to play golf.

Recently I shared several characteristics of communities that I believe are a key part of what makes ImproveCareNow more than an improvement Network, but a real community. One of the characteristics is that communities are made up of smaller communities.

In ImproveCareNow there is no shortage of smaller communities. The wonderful thing about some of these is that they have developed organically. For example, if you are a physician, nurse, parent, dietitian, improvement coordinator, or social worker, you are now part of a small but vibrant community that includes others in that same role. Members of these groups help on-board and mentor each other, take on small projects that help the whole Network focus on issues related to IBD care that might be overlooked by other roles, and provide a social support system that helps make each individual’s ImproveCareNow journey just a little bit more inclusive and fun.

Many of these small communities emerged from the interest, motivation, ideas, and leadership of their members. They are now largely self-driven and are even beginning to branch out in inter-community collaborations as a result of a “project pitch” session at our Spring Community Conference. There are also groups of like-minded people who have common interests and want to take on a project together, small committees that form to address a specific issue, and groups of people working together to plan aspects of our webinars and Community Conferences.

Some of our other smaller communities have been developed by design. In ImproveCareNow we talk a lot about our “Learning Labs”, which are small groups of ICN care centers with similar characteristics like size or organizational structure. Learning Labs enable centers to work more closely together to catalyze improvement and—perhaps more importantly—maintain that “small town” feeling that is such an important ingredient in our Network.

Why did we decide it was important to create Learning Labs? Back in 2008, there were eight ICN care centers. Everyone knew one another, all were aware of the projects that other centers were working on, the volume of messages on our listerv was not overwhelming, and our monthly webinars were full of lively, uninhibited conversation. Sharing was easy and the conversations were manageable; I like to say that we didn’t need the “mute” button on our webinars.

But as we grew these conversations became harder to manage; the background noise from many clinical settings was more distracting, the volume of e-mails in which centers shared updates and ideas was becoming frustrating to our participants, and there were more faces and names to remember. As a result, ICN leadership found ourselves doing more talking and the ICN care center teams doing more listening and less teaching and responding. Literally and figuratively, the Network was getting noisy and quiet at the same time. The most concerning side-effect was that big ideas that needed to be shared were getting drowned out by the noise—from a nurse who didn’t want to speak up on a large conference call to a parent partner who had a great idea but was concerned about putting it out there for the whole Network to see. It became challenging to maintain our ability to collaborate and share seamlessly. So we decided to try breaking out into smaller groups – much like we do during our Community Conferences – to increase our capacity for active and meaningful participation.

And so the ImproveCareNow Learning Labs were born.

Today we have seven Learning Labs. Each lab is guided by an assigned quality improvement coach and meets via webinar every other month to share lessons learned from quality improvement projects, share and discuss their center-specific data and outcomes, and develop ideas for collaboration. The labs spend time working together and sharing their progress at our Community Conferences; and they review written summaries of the best quality improvement ideas and barriers taking place within their Learning Lab on a regular basis so they can identify ways to accelerate their progress as a group.

We apply quality improvement principles to everything we do in ImproveCareNow, including testing changes and observing the results to determine whether they result in an improvement. The same is true for our Learning Lab model. What have we observed about the Learning Labs so far? We have seen stronger relationships form in these groups and have seen centers that would not previously have collaborated share ideas and launch projects together. We have seen nurses, improvement coordinators, and patient and parent partners speak up and teach on Learning Lab calls in ways they were not previously comfortable doing. The Learning Labs have also helped our leadership team achieve some key community-building goals:

The Learning Labs have become a fun and meaningful part of the ImproveCareNow journey. But there is so much more to learn about their impact on our centers, our Network outcomes, and on the participant experience. And knowing this community, they will look very different two years from now than they do today!

I am hoping that readers from our ImproveCareNow centers will share their experience with being in Learning Labs in the comments section below. How have they enhanced your experience? How would you change them for the better?

I am writing this having just returned from several whirlwind days in Chicago at the first ever ImproveCareNow Community Conference. The ImproveCareNow Network has come together in person twice a year for seven years, but this was the first time this gathering was not called a Learning Session—the traditional Quality Improvement Collaborative term for in-person meetings. We changed the name for several reasons, the most important being that ImproveCareNow is now indeed a community. Here are some reasons why:

We have each of these things in ImproveCareNow and in future LOOP posts I will share examples of each. But one that I didn’t list,which became very clear to me at the conference, is that the best communities take risks together. I want to share a bit more about that here.

One of our conference goals was to brainstorm new interventions—in QI-speak, “changes to test,” - that will help us get even more kids with Crohn's disease and ulcerative colitis into remission. Prior to the conference, we developed a new list of key drivers—or focus areas—that we thought were most important to improvement. Now it was time to crowd-source the best ideas for interventions to tackle in each area. This tends to be the most fun part of the process!The ImproveCareNow Network has developed interventions together before. But this time, we wanted to make sure our incredible diversity and stakeholder engagement was really reflected in these new interventions. In the weeks leading up to the conference, each center interviewed patients and parents to get input on challenges and opportunities in each Key Driver area. In doing so, they opened themselves up to a variety of feedback; I know this felt risky to some centers.

But as a community we took the risk together. Prior to the conference, nearly all of our 254 participants chose the three Key Drivers that most interested them. Once we received their choices, we put together small groups (6-9 people) that were as diverse as possible-blending people from different centers and with most groups including at least one patient, one parent, and others from several clinical roles. Planning this felt risky even as it felt like the right thing to do. Would people want to spend almost two hours of valuable conference time in an informal exercise with people outside of their peer groups? Would lone parents and patient at the tables feel overwhelmed, ignored, or vulnerable? Would conversations stall with the minutes ticking by slowly?

It ended up being a risk well worth taking. Between 2:00 pm and 4:30 pm on Saturday the low, quiet, steady buzz of conversation eased all of my concerns about people diving in and learning with those very different from themselves. Many observers noted that as  groups tackled the provided questions, the first thing they did was turn to the parent or patient at the table—deferring to their expertise. When each of the three 40-minute discussion periods ended, we worked harder than expected to get each group to wrap up and move to their next tables. And the notes that were shared—and will guide our work in the months and years ahead—are full of some of the richest, most diverse insights I’ve seen in my quality improvement career.

We work hard to make sure all participants in this community have the quality improvement structure, skills, and tools to achieve their goals. Even more important is making sure the right centers and people connect so they can do more together than alone. We foster this online on our ICN Exchange knowledge commons, on monthly webinars, and at our Community Conferences. Admittedly, this gets a bit more challenging as we grow and we don’t always get it right. But what these collaboration sessions showed me is that community members desperately want to keep connecting across roles and centers and that they embrace the expertise of everyone at the table. They are building their own momentum and will continue to do so even as we get bigger and push our network infrastructure to keep up. So thank you to the ImproveCareNow community for taking risks together, leaving roles and titles aside, and creating a better today and tomorrow for and with kids with IBD.

The IBD Learning Priorities project was designed to give young adults, parents and clinicians in the IBD community a chance to ask the questions they felt were most important in the treatment of IBD. Using an online survey, families and clinicians submitted over 200 questions - or 'learning objectives'. Common themes included diet, diagnosis and individual care needs.

These questions will help us further understand what information those who are impacted by IBD really need. We expect to find some of these questions already have answers. And where there there is good research to answer these common questions, ImproveCareNow will work to develop and share this knowledge through family-centered tools and resources. Those questions that do not have complete answers will help prioritize future pediatric IBD research.

Below are a few examples of the learning objectives received from families and clinicians like you!

• Beyond enteral therapy, what is the role of diet in the maintenance of remission in IBD?

• Is 6mp safe? Will it hurt her liver anymore than it already is?

• We need more data on dual therapy with thiopurines and methotrexate. Specifically, will patients do better if these agents are started before starting biologics rather than starting them at the same time?

Stay connected with ImproveCareNow by joining our CIRCLE so we can send you updates on the continued progress of these important community-developed learning objectives and ensure you have access to the family-centered tools and information that are developed in response to some of these questions.

What does an engagement campaign have to do with a healthcare quality improvement network? ImproveCareNow leaders were wondering the exact same thing before we began learning from our friends at 270 Strategies (experts in both political and issue campaigns!) Their team is teaching us how to apply successful campaign strategies to engage a large and diverse community of people in helping kids with IBD get better, now. Quite simply, ImproveCareNow invites clinicians, parents, patients, researchers, and others to learn about our work and to lend their time, talents, and expertise so together we can learn and find innovative new ways to outsmart IBD. And right now we’re learning how to make it easy for everyone to connect with ImproveCareNow in the ways that work best for them and ensure we can harness and value each person’s unique and generous contributions - making it meaningful and rewarding to be a part of our community.

In ImproveCareNow we always start with a small test. To that end six of our centers are diving in as campaign pilot centers. Cincinnati Children’s Hospital Medical Center, Children’s Mercy Hospital, Children’s Hospital of the King’s Daughters, Children’s Hospital of Philadelphia, Levine Children’s Hospital, and the University of Michigan CS Mott Children’s Hospital are getting some training, rolling up their sleeves, and re-framing what an ICN IBD team looks and feels like. You will hear more about their journeys in the coming months as they build momentum and start sharing what they have learned with the rest of the community. In the meantime, we wanted to highlight some of the work underway in the early days of the campaign so that you can begin to learn with us now:

Snowflakes and ImproveCareNow

Campaign pilot centers are beginning to reframe their ICN teams with the “snowflake model” in mind. The snowflake model is a way of organizing people that decentralizes leadership and increases two-way communication. Basically it makes it easier for everyone to share the work and contribute to the success. These centers have found that creating a snowflake does not necessarily mean more work for the existing team, rather, it often involves reassigning people in ways that make it easier to get existing work done more efficiently.

“Hard ask?” – that sounds hard!

As part of their training, the participating centers are learning that it’s OK to be really direct about what they need from potential partners. It is lot easier to say no when the ask is soft and non-specific. So rather than saying “Umm…I was thinking maybe you could help us out somehow in the next few months,” they are looking for ways to be very concrete when asking for help, “Please come to our QI meeting next Tuesday. We really need your input on our new diagnosis process.”

Everyone’s story matters, and is important, and can change someone else's story.

More than ever, we are seeing how stories are key to helping potential partners understand what ImproveCareNow is all about and how they can fill important gaps in the community. Our Spring Community Conference is just around the corner and we are seeing some inspiring stories as part of the pre-work, stories that make very clear just how much our Network attracts those who want to join in and become a part of our success.

What this means to patients and families.

We know that growing our community will only make us stronger…indeed, the theme of our Spring Community Conference is “Strength in Our Numbers”! In her beautifully written LOOP post ‘Breaking a Promise’ Sami Kennedy really drove this point home. She reminded us why being part of ImproveCareNow is important and empowering for individuals, just as it is important to the whole community. As she says, “I have been welcomed into an environment where I am encouraged to not only sit at the table, but also to stand up and address the whole room.”

Meanwhile, we still have a lot to learn.

As the campaign unfolds, the ImproveCareNow leadership team knows it has an enormous responsibility to continue to ensure the network’s success, and to help develop a system that offers tools and opportunities for co-producing health and real partnerships. And we will be the first to admit, we have a lot to learn! We need your input as we go. We want to have open, transparent discussions about the challenges and opportunities ahead so we hope to engage more of you on twitter and other social media venues to take part in an ongoing dialogue between Community Conferences and webinars. You can follow @myers3411, @michaelseid11, @PeterAMargolis, and @improvecarenow on twitter and weigh in with your feedback and concerns as we build a bigger, better community together.

The goal of medical research is to find answers that will improve the lives of patients. But how can we be sure the answers really matter if we don’t ask patients what they want and need to know?

ImproveCareNow is committed to supporting research that represents patient and family perspectives. As part of our funding from the Patient Centered Outcomes Research Institute and the US Agency for Healthcare Research and Quality, we are working with leading health care researchers from Children's Hospital of Philadelphia, Katherine Bevans, PhD and Chris Forrest, MD, PhD (selected publications by Dr. Forrest) to use new ways to engage everyone in the IBD community in setting our direction for learning. They have created a website called Patient Priorities to find out what YOU want and need to know about Crohn’s disease and ulcerative colitis (IBD). You don’t need any research experience to participate.

You will be asked to recall moments during your/your child’s diagnosis and/or treatment when you wanted more information, or had questions that were not answered. Maybe you had questions when comparing two treatment options, or making the decision to end a particular treatment. Any difficult moment when you needed more clarity and information is important for researchers to know about.

Responses to the 10-minute survey are anonymous and will be grouped with many other responses to develop a list of “Learning Objectives.”  Some Learning Objectives may be answered using existing research. Where there is good research to answer common questions, ImproveCareNow will be making more tools and resources for families available through care centers and in our online communities: Facebook, Twitter, here on LOOP, CIRCLE, the ICN Exchange and Smart Patients. Those Learning Objectives that are unanswered and require more research will be added to the ImproveCareNow research agenda.

We’ve heard from many patients with IBD and their parents. It would be great to hear from many more to be sure the Learning Objectives really represent a wide variety of experiences.

Here’s your survey: http://bit.ly/lrnobjs

This is an important opportunity for us to shape the future of IBD research. We will be sharing our results and what we’ve learned along the way, so you can see how we’re outsmarting IBD together.

A few months back I wrote about the importance of stories as we work together to improve care for  kids with Crohn’s disease and ulcerative colitis. And what a wonderful collection of stories we are building! But we also know that data and measurable outcomes (like % of kids in remission, and % of kids NOT taking steroids) are really important too. One of the most important tools ImproveCareNow (ICN) teams use is called 90-day goals.

90-day goals are meant to ground and shape teams’ quality improvement (QI) work. Teams use QI to see where the gaps are in the care they deliver to each patient, and all patients, they see with IBD, and figure out the best ways to close those gaps (or make real improvements in care and outcomes). These goals also provide a rallying point for team members, keeping them aligned, focused, and motivated. Done well, 90-day goals are incredibly motivating and help the team strive to achieve big things together, while also honing in on the individual (sometimes nebulous) ideas for improvement. In QI it is always important to refine your goal or aim into something specific, measurable, (hopefully) achievable, realistic, and time-bound (SMART).

I have been reflecting on the diverse goals that ICN teams set for the last quarter of 2014. I want to share some of my favorites - and give you a little snapshot of the work that is going on across the Network. Whether new to the Network or having years of experience with collaborative quality improvement, ICN centers are working to create systems that are sustainable and manageable, to better understand the needs of individual patients and groups of patients, and of course to get more patients into remission and keep them there.

A brand new center: “We will register 70 patients total (50% of our estimated eligible population).” This reflects an important focus on the basics—getting patients into the ICN registry so they can benefit from the tools available to learn from their data and make related improvements in care.

A team that is gaining momentum after about six months of participation in ImproveCareNow: “Each faculty will review a Pre-Visit Plan on at least 25% of their IBD patients.” This center has worked hard to get patients into the ImproveCareNow registry. They are now ready to focus becoming a proactive, prepared practice team—assessing the needs of patients prior to visits. They are starting small so that they can test different changes and learn as they go…before spreading to even more patients.

A “veteran” team aiming to make sure that patients transitioning to adult care are prepared for that major milestone: “By December 31, 2014, we will achieve…20% increase in patients 16-18 years old with a transition plan.” This center knows that transition to adult care is so much more than just making a referral to an adult physician. They want to know that their patients have the knowledge, skills, and tools they need to navigate that journey.

And a team that has already achieved an impressive 80% remission rate, pushing to see how high they can go: “By December 31 2014, the remission rate will  consistently be 85% two of the three months of the quarter.” This center has built a reliable, proactive, and patient-centered system. They and others are setting a new bar for the outcomes that are possible when all members—patients, parents, clinicians, and improvers—work together!

It can be hard to explain what a complex system like ImproveCareNow is all about. There are a lot of moving parts! After all, we can all agree health care is very complex! As a leader in this network, I know we often talk about the big innovations, the patient stories, and the work we do to keep this community connected across the miles. But these individual goals give a real concrete look at part of the foundation of this network’s success. The day-to-day, on-the-ground work that goes on at 71 (and counting!) ICN care centers across the US and UK.

It’s important to point out that the goals of brand new teams, which focus on ensuring every patient with IBD is included in the ImproveCareNow registry and that data is 100% complete and accurate,  are no less important than the goals of more experienced teams. Once a solid foundation for improvement is laid, teams are able to focus on achieving even better outcomes (like higher remission rates). It is a continuum—a journey that all centers begin when they join ImproveCareNow. And as a Network that encourages “seamless sharing and shameless stealing,” none of the centers are working toward these goals alone. Experienced teams become mentors and coaches for newer teams even as they work toward their own goals.  And newer teams are able to go further, faster because we’re all in this together.

Thank you to the ImproveCareNow teams for another amazing set of goals. We can’t wait to see what you achieve together!

[Editor's note: Ask your care team about their ImproveCareNow goals next time you're in clinic.They'd be glad to share! Not sure if you're at an ICN center, find out here.]