Compliance With American Gastroenterological Association Inflammatory Bowel Disease Quality Measures

Abstract

Introduction: Insurance companies use quality metrics to construct reimbursement rates based on physician compliance with quality measures (QM). The American gastroenterological association (AGA) established a set of quality metrics for inflammatory bowel disease (IBD). Our goal was to assess compliance with QM in a large academic practice (AC), community hospital (CH), and large private practice gastroenterology group (PP). Methods: Of the 10 QM established by the AGA, 8 pertain to outpatient management of IBD. All patients with IBD seen in gastroenterology clinics in April 2013 at an AC, the year 2013 at a CH and in February 2014 at a PP were prospectively included in this study. Seven hundred eighty-four patients were included. All charts were reviewed for compliance with applicable QM as documented within the last 12 months. Records were also assessed for the type of IBD, year of diagnosis, number of medications, comorbidities, hospitalizations in the last year, gastroenterology clinic visits in the last year, whether the patient was seen by specialist in IBD or seen in conjunction with a trainee, as well as physician demographics. Univariate and multivariate statistical analysis was done using STRATA. Results: Seven hundred eighty-four patients were seen (367 AC, 217 CH, 200 PP). Of the patients, 55.1% (n=432) of patients had Crohn’s disease, 42.5% (n=341) had ulcerative colitis, and 1.4% (n=11) had indeterminate colitis. Of the patients, 58.6% (n=458) patients were female. The median age was 44 (range 17-92) with a median year of IBD diagnosis of 2004 (range 1945-2014). Screening for tobacco use was the most frequently assessed (89.6% n=701/783) core measure, followed by assessment for corticosteroid sparing therapy (81.6%, n=278/337), and location of IBD (80.2%, n=629/784). In contrast, the least frequently evaluated core measure was pneumococcal immunization (16.7% n=131/783), followed by assessment of bone loss (20.1% n=126/625), and influenza immunization (28.7% n=225/783). Only 5.9% (46/784) of patients had all applicable core measures evaluated and documented. In univariate analysis, the mean age (p value of 0.044) year of IBD diagnosis (p value 0.004), number of comorbidities (p value 0.009), number of medications (p value 0.003) being seen by a specialist in IBD (p value 0.001) were associated with having all core measures assessed. In multivariate analysis, only being seen by a specialist in IBD (p value 0.005, 95% confidence interval [CI] 0.21-0.115), number of comorbidities (p value 0.009, 95% CI 0.001-0.011), and number of medications (p value 0.006, 95% CI 0.001-0.106) remained significant. Conclusion: Our study demonstrates overall poor compliance with current AGA IBD QM. Additional studies are needed to determine potential causes of failure to comply with the IBD QM. Disclosure - Daniel Leffler - Consulting: Alba, Alvine, Shire, Ironwood. Adam S. Cheifetz - Consulting: Janssen-Cilag, Abbott Laboratories; Grant/Research Support: Pfizer. The following people have nothing to disclose: Sana S. Siddique, Joseph D. Feuerstein.