809 Making Time for Health Maintenance: A Busy Clinic's Quality Improvement Study of the Inflammatory Bowel Disease Population

Abstract

INTRODUCTION: Inflammatory bowel disease (IBD) patients require a special focus on health maintenance. However, many studies demonstrate surprisingly inadequate compliance in various categories. Surveys have shown that they are at an increased risk of acquiring influenza and are more likely to suffer its complications but vaccination rates remain low. Similarly, hepatitis vaccination remains inadequate despite the fact that most IBD patients regularly see a gastroenterologist. Other studies show that women with IBD are less likely to have updated cervical cancer screening but are more likely to have high-grade dysplasia or cancer. Additionally, despite advancements in IBD management, lifetime rates of osteoporosis remain as high as 70%. The current guidelines offer detailed recommendations but, despite the capable providers, motivated patients, and the many visits, prevalence of adequate preventive care remains low. We offer one example of a structured quality improvement study in a busy “real world” clinic using sustainable measures easily incorporated into the typical day. METHODS: Using the existing American College of Gastroenterology guidelines for preventive care, we evaluated our baseline compliance and developed quality improvement cycles. First intervention was a checklist incorporated into each IBD patient's visit note, regardless of the reason for the visit. We then assessed which areas, if any, demonstrated improvement. We used the following cycles to focus on the most clinically relevant (eg. tuberculosis screening prior to biologic therapy) and those with lowest baseline numbers (eg. use of symptom scores). Each 60-day cycle was then evaluated by a detailed review of at least 30 patient charts each averaging 1.25 visits during study period. RESULTS: Baseline data demonstrated low compliance with measures such as tuberculosis screening every 12 months (55.9%), TPMT enzyme assay (75%), vaccination (ranging 2.04-14.9%), among others. Despite the low utilization of the checklist at 23% in first 60 days, various categories improved, including rate of reproductive health counseling (from 10.2% to 31.4%), hepatitis B vaccination (from 14.9% to 30.7%), DEXA scans (4.08% to 15.4%), among others (see Table 1). CONCLUSION: Our quality improvement study shows that a step-wise use of simple interventions is a durable way to improve compliance with guidelines to offer comprehensive and thoughtful care. Future cycles will include increased patient engagement and collaboration with ancillary services.