Inflammatory Bowel Diseases Dedicated Gastroenterologists Have Greater Adherence to Clinical Care Quality Indicators Than General Gastroenterologists

Abstract

Introduction: The wide variation of care received by patients with inflammatory bowel disease (IBD) is a surrogate for poor clinical outcomes. Physician performance measures and quality of care indicators for IBD were developed by the American Gastroenterological Association (AGA) and the Crohn's and Colitis Foundation of America (CCFA) with the goal to improve clinical outcomes, quality of life, and decrease healthcare costs. The aim of our study was to assess adherence to IBD quality of care indicators at a tertiary academic center by IBD-dedicated gastroenterologists (IBD-GIs) compared to general gastroenterologists practicing in the community that manage IBD patients (Gen-GIs). Methods: A prospective review (January 1, 2017 to April 30, 2017) was conducted of consecutive outpatient visits at the gastroenterology clinic at Washington University in Saint Louis. Demographics and established quality of care indicators in IBD as published by AGA and CCFA were collected: documentation of IBD phenotype, vaccination status, and appropriate endoscopic evaluation. We compared adherence to quality of care indicators by IBD-GIs managing established IBD patients vs referred patients with IBD managed by community Gen-GIs using t-test and Chi square (Prism, Irving CA). Results: Over the study period, 478 patients (median age 42 years, 51% female, 14% African American) were evaluated in the clinic. Disease duration was a median of 14 years, and 55% had Crohn's disease. 235 patients were managed by IBD-GIs and 248 were managed by Gen-GIs with similar demographics among the two groups. IBD-GIs were significantly more compliant with recommended quality of care indicators compared to Gen-GIs, including IBD phenotype documentation, vaccination practices, corticosteroid usage, colonoscopy for colon cancer surveillance, and endoscopy as part of treat-to-target therapy or to detect post-surgical recurrence (Table 1).Table: Table. Comparison of adherence to IBD quality of care indicatorsConclusion: IBD-GIs compared to Gen-GIs are consistently and significantly more adherent in the implementation of quality of care indicators for IBD. Our data suggest that patients with IBD might benefit from focused and comprehensive clinical care by IBD-dedicated gastroenterologists. Furthermore, the study highlights the need for further training and education of Gen-GI physicians in areas where specialized IBD care is not currently available.