Quality of care in inflammatory bowel disease: results of a prospective controlled cohort study in Germany (NETIBD)

Abstract

Jana Langbrandtner,1,* Angelika Hüppe,1,* Petra Jessen,2 Jürgen Büning,3 Susanna Nikolaus,4 Heiner Raspe,5 Bernd Bokemeyer6 1Institute of Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee, Luebeck, 2Gastroenterology Practice Altenholz-Kiel, Erdbeerfeld, Altenholz, 3Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee, Luebeck, 4Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstraße, Kiel, 5Center for Population Medicine and Health Services Research, University of Luebeck, Ratzeburger Allee, Luebeck, 6Gastroenterology Practice Minden, Uferstraße, Minden, Germany *These authors contributed equally to this work Background/aims: Patients with inflammatory bowel disease (IBD) need comprehensive, interdisciplinary and cross-sectoral health care. In Germany, evidence-based care pathways have been developed to improve the quality of care of IBD patients. We aimed to evaluate the effects of the implementation of some of these recommendations on patient-related outcomes.Methods: In a region of North Germany, outpatients with IBD were recruited by gastroenterologists (intervention group). Three activities based on the recommendations of the IBD pathways were implemented, namely, 1) patient participation in a questionnaire-based assessment of 22 somatic and psychosocial problems combined with individualized care recommendations (patient activation procedure); 2) patient invitation to participate in a 2-day patient education program and 3) invitation to their gastroenterologists to participate in periodic interdisciplinary case conferences. For the control group, IBD patients receiving standard care at gastroenterology practices outside the specified region were recruited by their doctors. At baseline, 6- and 12-month follow-up, study patients were invited to complete questionnaires. Generic health-related quality of life, social participation and self-management skills were the main outcomes.Results: At baseline, 349 patients were included in the study (intervention group: 189; control group: 160); 142 patients from the former and 140 from the latter group returned completed questionnaires at the 12-month follow-up. Over time, improvement in health-related quality of life and social participation was similar in both groups. Participants of the intervention group demonstrated improved self-management skills and more often followed steroid-free medication regimens.Conclusion: In a real-world clinical context, patient activation procedure combined with patient education and case conferences was less effective than expected. The observed beneficial effects, however, encourage the evaluation of more intensive and addressee-centered activities. Keywords: Crohn’s disease, ulcerative colitis, IBD care pathways, quality of care, implementation, evaluation, health services research

Keywords

• inflammatory bowel disease
• IBD care pathways
• quality of care
• implementation
• evaluation
• health services research