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Improving Anemia in Inflammatory Bowel Disease: Impact of the Anemia Care Pathway
Talha Qureshi1,2, T Peter Nguyen3, Ruifei Wang3
1Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA.
Insights
The Anemia Care Pathway (ACP) improved iron therapy for inflammatory bowel disease (IBD) patients, reducing anemia prevalence. However, iron deficiency screening did not improve, indicating areas for future refinement.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Practice Improvement
Background:
- Anemia is a frequent complication of inflammatory bowel disease (IBD), often undertreated despite existing guidelines.
- High anemia prevalence in IBD necessitates improved management strategies.
- The Crohn's and Colitis Foundation developed the Anemia Care Pathway (ACP) to address this clinical gap.
Purpose of the Study:
- To implement the Anemia Care Pathway (ACP) within a managed care setting.
- To identify improvements in clinical practice habits related to anemia management in IBD.
- To pinpoint persistent barriers to optimal anemia care in IBD patients.
Main Methods:
- Retrospective study of the Anemia Care Pathway (ACP) implementation from July 2016 to June 2017.
- Utilized run charts to track shifts in iron deficiency screening, iron therapy, and anemia prevalence.
- Compared outcomes in clinics using the ACP with those not using the ACP.
Main Results:
- In the ACP clinic, iron therapy for anemic IBD patients increased from 30% to 80% of encounters.
- Anemia prevalence in the ACP clinic decreased significantly, from 48% to 25%.
- No improvements in iron deficiency screening rates were observed; no practice shifts occurred in non-ACP clinics.
Conclusions:
- The Anemia Care Pathway (ACP) shows potential in reducing missed iron therapy opportunities and decreasing anemia prevalence in IBD.
- Significant gaps in screening for iron deficiency persist despite ACP implementation.
- Future iterations of the ACP should focus on enhancing screening protocols and follow-up care for IBD-related anemia.
Background:
Anemia is a common complication of inflammatory bowel disease (IBD). Despite existing guidelines for anemia in IBD, it is frequently under-treated and the prevalence of anemia has remained high. To address this gap, the Crohn's and Colitis Foundation developed the Anemia Care Pathway (ACP).
Aims:
To implement the ACP in a managed care setting and identify where it improves practice habits and where barriers remain.
Methods:
The ACP was implemented from July 2016 through June 2017 and retrospectively studied. Run charts were used to identify shifts in iron deficiency screening and treatment as well as anemia prevalence. Results were compared to those of other providers in the same center not using the ACP.
Results:
640 IBD encounters were studied. In the ACP clinic (n = 213), anemics received iron therapy in only 30% of encounters at baseline but improved to 80%. Concurrently, anemia prevalence decreased from 48 to 25%. Screening for iron deficiency, however, did not improve. No shifts were seen in the non-ACP clinics (n = 427) across the same period despite awareness of the ACP and other guidelines.
Conclusions:
Across 1 year, we observed gaps in the screening and treatment of anemia in IBD. Although screening rates did not improve, the ACP appeared to reduce missed opportunities for iron therapy by about half. Most importantly, this was associated with an overall decrease in anemia prevalence. Future refinements to the ACP should be focused on enhanced screening and follow-up.
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