Crohn's & Colitis Australia inflammatory bowel disease audit

measuring the quality of care in Australia

Wayne Massuger, Gregory TC Moore, Jane M Andrews, Monique F Kilkenny, Megan Reyneke, Simon Knowles, Liz Purcell, George Alex, Stephanie Buckton, Amy Theresa Page, Nigel Stocks, Don Cameron, Francesca Manglaviti, Paul Pavli

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Background: Australia has among the highest prevalence of Crohn disease and ulcerative colitis in the world. Management of the chronic gastrointestinal disorders results in significant societal costs and the standard of care is inconsistent across Australia. Aim: To audit the quality of care received by patients admitted for inflammatory bowel disease (IBD) across Australia against national IBD standards. Methods: A retrospective cross-sectional survey and clinical audit was undertaken assessing organisational resources, clinical processes and outcome measures. This study was conducted in Australian hospitals that care for inpatients with Crohn disease or ulcerative colitis. The main outcome measures were adherence to national IBD standards and comparison of quality of care between hospitals with and without multidisciplinary IBD services. Results: A total of 71 hospitals completed the organisational survey. Only one hospital had a complete multidisciplinary IBD service and 17 had a partial IBD service (IBD nurse, helpline and clinical lead). A total of 1440 inpatient records was reviewed from 52 hospitals (mean age 37 years; 51% female, 53% Crohn disease), approximately 26% of IBD inpatient episodes over a 12-month period in Australia. These patients were chronically unwell with high rates of anaemia (30%) and frequent readmissions (40% within 2 years). In general, care was inconsistent, and documentation was poor. Hospitals with a partial IBD service performed better in many processes and outcome measures: for example, 22% reduction in admissions through emergency departments and greater adherence to standards for safety monitoring of biological (89% vs 59%) and immunosuppressive drugs (79% vs 55%) in those hospitals than those without. Conclusion: Patients admitted to hospital suffering from IBD are young, chronically unwell and are subject to substantial variations in clinical documentation and quality of care. Only one hospital met accepted standards for multidisciplinary care; hospitals with even a minimal IBD service provided improved care.

Original languageEnglish
Pages (from-to)859-866
Number of pages8
JournalInternal Medicine Journal
Volume49
Issue number7
DOIs
Publication statusPublished - 1 Jul 2019

Keywords

  • clinical audit
  • Crohn disease
  • digestive system disease
  • gastroenterology
  • inflammatory bowel disease
  • ulcerative colitis

Cite this

Massuger, Wayne ; Moore, Gregory TC ; Andrews, Jane M ; Kilkenny, Monique F ; Reyneke, Megan ; Knowles, Simon ; Purcell, Liz ; Alex, George ; Buckton, Stephanie ; Page, Amy Theresa ; Stocks, Nigel ; Cameron, Don ; Manglaviti, Francesca ; Pavli, Paul. / Crohn's & Colitis Australia inflammatory bowel disease audit : measuring the quality of care in Australia. In: Internal Medicine Journal. 2019 ; Vol. 49, No. 7. pp. 859-866.
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title = "Crohn's & Colitis Australia inflammatory bowel disease audit: measuring the quality of care in Australia",
abstract = "Background: Australia has among the highest prevalence of Crohn disease and ulcerative colitis in the world. Management of the chronic gastrointestinal disorders results in significant societal costs and the standard of care is inconsistent across Australia. Aim: To audit the quality of care received by patients admitted for inflammatory bowel disease (IBD) across Australia against national IBD standards. Methods: A retrospective cross-sectional survey and clinical audit was undertaken assessing organisational resources, clinical processes and outcome measures. This study was conducted in Australian hospitals that care for inpatients with Crohn disease or ulcerative colitis. The main outcome measures were adherence to national IBD standards and comparison of quality of care between hospitals with and without multidisciplinary IBD services. Results: A total of 71 hospitals completed the organisational survey. Only one hospital had a complete multidisciplinary IBD service and 17 had a partial IBD service (IBD nurse, helpline and clinical lead). A total of 1440 inpatient records was reviewed from 52 hospitals (mean age 37 years; 51{\%} female, 53{\%} Crohn disease), approximately 26{\%} of IBD inpatient episodes over a 12-month period in Australia. These patients were chronically unwell with high rates of anaemia (30{\%}) and frequent readmissions (40{\%} within 2 years). In general, care was inconsistent, and documentation was poor. Hospitals with a partial IBD service performed better in many processes and outcome measures: for example, 22{\%} reduction in admissions through emergency departments and greater adherence to standards for safety monitoring of biological (89{\%} vs 59{\%}) and immunosuppressive drugs (79{\%} vs 55{\%}) in those hospitals than those without. Conclusion: Patients admitted to hospital suffering from IBD are young, chronically unwell and are subject to substantial variations in clinical documentation and quality of care. Only one hospital met accepted standards for multidisciplinary care; hospitals with even a minimal IBD service provided improved care.",
keywords = "clinical audit, Crohn disease, digestive system disease, gastroenterology, inflammatory bowel disease, ulcerative colitis",
author = "Wayne Massuger and Moore, {Gregory TC} and Andrews, {Jane M} and Kilkenny, {Monique F} and Megan Reyneke and Simon Knowles and Liz Purcell and George Alex and Stephanie Buckton and Page, {Amy Theresa} and Nigel Stocks and Don Cameron and Francesca Manglaviti and Paul Pavli",
year = "2019",
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Massuger, W, Moore, GTC, Andrews, JM, Kilkenny, MF, Reyneke, M, Knowles, S, Purcell, L, Alex, G, Buckton, S, Page, AT, Stocks, N, Cameron, D, Manglaviti, F & Pavli, P 2019, 'Crohn's & Colitis Australia inflammatory bowel disease audit: measuring the quality of care in Australia', Internal Medicine Journal, vol. 49, no. 7, pp. 859-866. https://doi.org/10.1111/imj.14187

Crohn's & Colitis Australia inflammatory bowel disease audit : measuring the quality of care in Australia. / Massuger, Wayne; Moore, Gregory TC ; Andrews, Jane M; Kilkenny, Monique F; Reyneke, Megan; Knowles, Simon; Purcell, Liz; Alex, George; Buckton, Stephanie; Page, Amy Theresa; Stocks, Nigel; Cameron, Don; Manglaviti, Francesca; Pavli, Paul.

In: Internal Medicine Journal, Vol. 49, No. 7, 01.07.2019, p. 859-866.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Crohn's & Colitis Australia inflammatory bowel disease audit

T2 - measuring the quality of care in Australia

AU - Massuger, Wayne

AU - Moore, Gregory TC

AU - Andrews, Jane M

AU - Kilkenny, Monique F

AU - Reyneke, Megan

AU - Knowles, Simon

AU - Purcell, Liz

AU - Alex, George

AU - Buckton, Stephanie

AU - Page, Amy Theresa

AU - Stocks, Nigel

AU - Cameron, Don

AU - Manglaviti, Francesca

AU - Pavli, Paul

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: Australia has among the highest prevalence of Crohn disease and ulcerative colitis in the world. Management of the chronic gastrointestinal disorders results in significant societal costs and the standard of care is inconsistent across Australia. Aim: To audit the quality of care received by patients admitted for inflammatory bowel disease (IBD) across Australia against national IBD standards. Methods: A retrospective cross-sectional survey and clinical audit was undertaken assessing organisational resources, clinical processes and outcome measures. This study was conducted in Australian hospitals that care for inpatients with Crohn disease or ulcerative colitis. The main outcome measures were adherence to national IBD standards and comparison of quality of care between hospitals with and without multidisciplinary IBD services. Results: A total of 71 hospitals completed the organisational survey. Only one hospital had a complete multidisciplinary IBD service and 17 had a partial IBD service (IBD nurse, helpline and clinical lead). A total of 1440 inpatient records was reviewed from 52 hospitals (mean age 37 years; 51% female, 53% Crohn disease), approximately 26% of IBD inpatient episodes over a 12-month period in Australia. These patients were chronically unwell with high rates of anaemia (30%) and frequent readmissions (40% within 2 years). In general, care was inconsistent, and documentation was poor. Hospitals with a partial IBD service performed better in many processes and outcome measures: for example, 22% reduction in admissions through emergency departments and greater adherence to standards for safety monitoring of biological (89% vs 59%) and immunosuppressive drugs (79% vs 55%) in those hospitals than those without. Conclusion: Patients admitted to hospital suffering from IBD are young, chronically unwell and are subject to substantial variations in clinical documentation and quality of care. Only one hospital met accepted standards for multidisciplinary care; hospitals with even a minimal IBD service provided improved care.

AB - Background: Australia has among the highest prevalence of Crohn disease and ulcerative colitis in the world. Management of the chronic gastrointestinal disorders results in significant societal costs and the standard of care is inconsistent across Australia. Aim: To audit the quality of care received by patients admitted for inflammatory bowel disease (IBD) across Australia against national IBD standards. Methods: A retrospective cross-sectional survey and clinical audit was undertaken assessing organisational resources, clinical processes and outcome measures. This study was conducted in Australian hospitals that care for inpatients with Crohn disease or ulcerative colitis. The main outcome measures were adherence to national IBD standards and comparison of quality of care between hospitals with and without multidisciplinary IBD services. Results: A total of 71 hospitals completed the organisational survey. Only one hospital had a complete multidisciplinary IBD service and 17 had a partial IBD service (IBD nurse, helpline and clinical lead). A total of 1440 inpatient records was reviewed from 52 hospitals (mean age 37 years; 51% female, 53% Crohn disease), approximately 26% of IBD inpatient episodes over a 12-month period in Australia. These patients were chronically unwell with high rates of anaemia (30%) and frequent readmissions (40% within 2 years). In general, care was inconsistent, and documentation was poor. Hospitals with a partial IBD service performed better in many processes and outcome measures: for example, 22% reduction in admissions through emergency departments and greater adherence to standards for safety monitoring of biological (89% vs 59%) and immunosuppressive drugs (79% vs 55%) in those hospitals than those without. Conclusion: Patients admitted to hospital suffering from IBD are young, chronically unwell and are subject to substantial variations in clinical documentation and quality of care. Only one hospital met accepted standards for multidisciplinary care; hospitals with even a minimal IBD service provided improved care.

KW - clinical audit

KW - Crohn disease

KW - digestive system disease

KW - gastroenterology

KW - inflammatory bowel disease

KW - ulcerative colitis

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U2 - 10.1111/imj.14187

DO - 10.1111/imj.14187

M3 - Article

VL - 49

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JO - Internal Medicine Journal

JF - Internal Medicine Journal

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