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Collaborative Network Improves Care At Least as Much as Would New Drug

Wednesday, March 14, 2012

When physicians work together effectively it can accelerate improvements in quality of care. That’s the lesson from a new study by ImproveCareNow, a national quality improvement and research network.

The study, published online in Pediatrics, the journal of the American Academy of Pediatrics, demonstrates a marked improvement in the outcomes of patients with inflammatory bowel disease (IBD) – Crohn’s disease or ulcerative colitis.

“The proportion of children with Crohn’s disease who were in remission increased from 55 percent to 68 percent, with a similar improvement in children with ulcerative colitis – all without new medicines,” says Wallace Crandall, MD, lead author of the study, director of the Center for Pediatric and Adolescent Inflammatory Bowel Disease at Nationwide Children’s Hospital and ImproveCareNow physician leader. “There had been virtually no improvement in IBD outcomes for decades, until now.”

“IBD management varies greatly throughout the country due to a lack of consensus on best practices and inadequate care delivery systems,” adds Dr. Crandall. “Outside of ImproveCareNow, IBD patients receive differing diagnostic, treatment and nutritional interventions, sub-optimal medication dosages, prolonged prescription of corticosteroids, and fail to receive steroid-sparing agents.”

Cincinnati Children’s is the coordinating center for the ImproveCareNow Network, which is based at the University of Vermont under the direction of Richard Colletti, MD. The network was formed in 2007 to improve the care and outcomes of children with Crohn’s disease and ulcerative colitis. It has grown to include 33 centers with 300 gastroenterologists and 10,000 patients. The network developed a set of recommendations to standardize diagnosis and treatment, classify disease severity and evaluate nutritional and growth status. Participating centers implemented these standards for their IBD patients.

Data were collected from six participating centers and included 1,188 children treated between July 2007 and April 2010. Findings showed improvements in specific care processes. While the proportion of Crohn’s disease and ulcerative colitis patients in remission increased, the percentage of Crohn’s disease patients taking corticosteroids decreased.

“The improvement we observed took place over a relatively short period of time during which no new therapies were introduced into routine clinical practice,” said co-author Michael Kappelman MD, MPH, assistant professor of Pediatrics at the University of North Carolina at Chapel Hill. Adds Dr. Colletti, “These improvements were likely the result of changes in the care delivery systems rather than a single specific intervention.”

Further study is needed to determine which combination of interventions is most important to improve the outcomes of these patients. But what is clear, according to Peter Margolis, MD, PhD, director of research at the James M. Anderson Center for Health Systems Excellence at Cincinnati Children’s Hospital Medical Center and co-author of the study, is that “forming an active, open learning community that is focused on data produces improvements in outcomes, as much as or more than a new drug. What if all kids could be part of a network like this? More than 10,000 would be in remission today.”

About Cincinnati Children’s

Cincinnati Children's Hospital Medical Center ranks third in the nation among all Honor Roll hospitals in U.S. News and World Report's 2011 Best Children's Hospitals ranking. It is ranked #1 for gastroenterology and in the top 10 for all pediatric specialties - a distinction shared by only two other pediatric hospitals in the United States. Cincinnati Children's is one of the top two recipients of pediatric research grants from the National Institutes of Health. It is internationally recognized for improving child health and transforming delivery of care through fully integrated, globally recognized research, education and innovation. Additional information can be found at www.cincinnatichildrens.org