Monitoring Enables Progress: A Nationwide Quality Improvement Program in Children With Crohn Disease

Area of Science:

• Pediatric Gastroenterology
• Quality Improvement Science
• Inflammatory Bowel Disease (IBD) Management

Background:

• Pediatric Inflammatory Bowel Disease (PIBD) requires consistent, high-quality care across healthcare facilities.
• Standardizing care and monitoring quality indicators are crucial for improving patient outcomes in PIBD.

Purpose of the Study:

• To establish a nationwide quality improvement program for PIBD in Israel.
• To prospectively record and analyze key quality indicators in pediatric Crohn's disease patients.
• To drive improvements in the clinical management of PIBD nationwide.

Main Methods:

• A Delphi group of representatives from all 21 PIBD facilities developed quality indicators.
• Data on process and outcome indicators were prospectively collected over two years for children aged 2-18 years.
• Monthly comparative reports were distributed to centers, and trends were analyzed using the Mann-Kendall test.

Main Results:

• Significant improvements were observed in process indicators, including anti-tumor necrosis factor (TNF) drug level monitoring, fecal calprotectin utilization, and bone density testing.
• Outcome indicators showed improvement, with increased rates of calprotectin <300 μg/mg and "resolution of inflammation".
• Biologic use increased, while immunomodulator use decreased, reflecting a shift in treatment strategies.

Conclusions:

• Nationwide quality improvement programs for PIBD can be implemented effectively, even with limited resources.
• These programs facilitate the standardization of care across different facilities.
• The program demonstrated an association with measurable improvements in key quality indicators for pediatric IBD patients.