Implementation of Outcome-Based Quality Improvement in Dutch Inflammatory Bowel Disease Centres

Outcome monitoring supports quality improvement (QI) by helping organisations track performance, identify gaps, and guide improvements. This is particularly important for the management of costly chronic diseases with high practice variation such as inflammatory bowel disease (IBD). Although the value of outcome data for QI is increasingly recognised, little is known about its use in practice. We explored how Dutch IBD centres implement outcome-based QI.

A survey was sent to 67 Dutch IBD centres covering outcome monitoring practices, data infrastructure, involvement of healthcare providers in QI discussions, and the perceived value of using outcomes for QI. Fourteen follow-up interviews explored experiences, barriers, and facilitators.

Twenty-eight centres were included (54% non-academic teaching, 25% academic, and 21% general hospitals), of which 79% regularly discussed outcomes within their IBD teams to support QI efforts. Of those, 95% implemented ≥ 1 QI initiatives annually informed by these discussions and 47% assessed their effectiveness regularly. However, consistent use of outcome-based QI was uncommon-only 18% discussed outcomes > 2 times per year. Commonly monitored outcomes were medication use (68%) clinician-reported outcomes (55%), and patient-reported outcomes (55%). Interviews revealed QI efforts were often limited by informal discussions that lacked aggregate data use and clear goals. Data systems were fragmented, and staff responsibilities were unclear. Staff engagement and management support were key enablers.

While outcome monitoring is common, it is not consistently used to support QI. Clarifying roles, improving data integration, and support in selecting meaningful outcomes may strengthen sustainable outcome-based QI.