Setting up an integrated service for PSC-IBD patients: A quality improvement project

Area of Science:

• Gastroenterology
• Hepatology
• Oncology

Background:

• Primary sclerosing cholangitis (PSC) frequently co-occurs with inflammatory bowel disease (IBD), increasing risks for cancer and mortality.
• Current surveillance guidelines for PSC-IBD patients lack uniformity, impacting quality of care.
• Local guidelines recommend annual surveillance using MRCP, colonoscopy, and US, with more frequent monitoring for cirrhotic patients.

Purpose of the Study:

• To evaluate the quality of care for patients with co-existing PSC and IBD.
• To assess adherence to surveillance guidelines before and after implementing an integrated outpatient service.
• To determine the impact of the integrated service on the detection of complications.

Main Methods:

• A retrospective and prospective data collection approach was used to compare patient management before and after service redesign.
• Descriptive analyses focused on diagnoses, surveillance adherence, and patient outcomes.
• Patient cohorts were compared pre- and post-implementation of the integrated PSC-IBD service.

Main Results:

• The integrated service led to 89 referrals and identified 68 PSC-IBD patients within 36 months.
• Surveillance rates significantly improved: 90% for colonoscopy, 81% for MRI/MRCP, and 35% for US, compared to baseline rates of 55%, 55%, and 7%.
• This improved surveillance resulted in the diagnosis and treatment of colonic dysplasia in 4 patients, colorectal cancer in 4, and cholangiocarcinoma in 2.

Conclusions:

• Establishing an integrated outpatient service for PSC-IBD patients enhances guideline compliance.
• The integrated service facilitates the effective detection of critical complications.
• Appropriate and timely management of PSC-IBD complications is achieved through this integrated approach.