Comparing guideline-based care quality for inflammatory bowel disease and rheumatoid arthritis patients within a medical home

Expert Rev Gastroenterol Hepatol. 2016 Jun;10(6):759-66. doi: 10.1586/17474124.2016.1169920. Epub 2016 Apr 12.

Abstract

Background: Rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) patient populations face similar risks of chronic immunosuppression including corticosteroid use. We compared the receipt of preventive services between IBD and RA populations according to published quality metrics.

Methods: We defined a single-center cohort of patients with IBD or RA receiving specialty and primary care. Electronic health record abstraction assessed quality metrics, sociodemographics, comorbidity, and utilization. Comparisons used multivariate odds ratios and Student's t-tests.

Results: 218 RA and 190 IBD patients were included. In multivariate analysis, IBD patients were less likely to receive pneumococcal vaccination (OR=0.29, 95% CI: 0.11-0.85), while RA patients underwent glucocorticoid-induced osteoporosis screening more often (100% vs. 82.5%, p = 0.023).

Conclusions: Gastroenterologists can improve care quality for IBD patients by assuming greater responsibility for preventive care in IBD patients and/or collaborating with primary care and health systems to improve preventive care delivery.

Keywords: Inflammatory bowel disease; preventive care; quality care; rheumatoid arthritis; vaccination.

Publication types

  • Comparative Study

MeSH terms

  • Academic Medical Centers
  • Adult
  • Aged
  • Arthritis, Rheumatoid / diagnosis
  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / immunology
  • Chi-Square Distribution
  • Comorbidity
  • Delivery of Health Care, Integrated / standards
  • Electronic Health Records
  • Female
  • Gastroenterologists / standards
  • Glucocorticoids / adverse effects
  • Guideline Adherence / standards*
  • Humans
  • Immunocompromised Host
  • Immunosuppressive Agents / adverse effects*
  • Inflammatory Bowel Diseases / diagnosis
  • Inflammatory Bowel Diseases / drug therapy*
  • Inflammatory Bowel Diseases / immunology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Opportunistic Infections / immunology
  • Opportunistic Infections / microbiology
  • Opportunistic Infections / prevention & control
  • Osteoporosis / chemically induced
  • Osteoporosis / diagnosis
  • Osteoporosis / prevention & control
  • Patient-Centered Care / standards*
  • Physician's Role
  • Pneumococcal Vaccines / therapeutic use
  • Practice Guidelines as Topic / standards*
  • Practice Patterns, Physicians' / standards*
  • Preventive Health Services / standards*
  • Primary Health Care / standards
  • Process Assessment, Health Care / standards*
  • Quality Indicators, Health Care / standards*
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Wisconsin
  • Young Adult

Substances

  • Glucocorticoids
  • Immunosuppressive Agents
  • Pneumococcal Vaccines