RESUMEN
BACKGROUND: Data on variation in outcomes and costs of the treatment of inflammatory bowel disease (IBD) can be used to identify areas for cost and quality improvement. It can also help healthcare providers learn from each other and strive for equity in care. We aimed to assess the variation in outcomes and costs of IBD care between hospitals. METHODS: We conducted a 12-month cohort study in 8 hospitals in the Netherlands. Patients with IBD who were treated with biologics and new small molecules were included. The percentage of variation in outcomes (following the International Consortium for Health Outcomes Measurement standard set) and costs attributable to the treating hospital were analyzed with intraclass correlation coefficients (ICCs) from case mix-adjusted (generalized) linear mixed models. RESULTS: We included 1010 patients (median age 45 years, 55% female). Clinicians reported high remission rates (83%), while patient-reported rates were lower (40%). During the 12-month follow-up, 5.2% of patients used prednisolone for more than 3 months. Hospital costs (outpatient, inpatient, and medication costs) were substantial (median: 8323 per 6 months), mainly attributed to advanced therapies (6611). Most of the variation in outcomes and costs among patients could not be attributed to the treating hospitals, with ICCs typically between 0% and 2%. Instead, patient-level characteristics, often with ICCs above 50%, accounted for these variations. CONCLUSIONS: Variation in outcomes and costs cannot be used to differentiate between hospitals for quality of care. Future quality improvement initiatives should look at differences in structure and process measures of care and implement patient-level interventions to improve quality of IBD care. TRIAL REGISTRATION NUMBER: NL8276.
Variation in outcomes and costs cannot be used to differentiate between hospitals for quality of inflammatory bowel disease care. Future quality improvement initiatives should look at differences in structure and process measures and implement patient-level interventions to improve quality of inflammatory bowel disease care.
RESUMEN
The treatment of patients with chronic inflammatory bowel disease (IBD) in accordance with the current guideline is generally successful but there is still a group of patients for whom the medication does not work. If the initially prescribed medication is not sufficiently effective, the tendency is to move on to a 'higher' class of drugs relatively quickly. This is not always necessary. If therapy fails then therapy compliance and dosage should first be examined. Measurement of the metabolites of purine analogues can be helpful in determining the optimal drug dosage. The results sometimes show that a previously-prescribed drug may still be an option. Despite its proven efficacy, methotrexate appears to be being prescribed less often. For those patients who do not respond adequately to the optimum dosage of anti-tumour necrosis factor (TNF), there are new drugs on the way. Vedolizumab, a leukocyte adhesion inhibitor, in particular is showing promising results.