P0510 Evaluation of organizational and healthcare provider level readiness in European Inflammatory Bowel Disease centres for outcome-based quality improvement
Authors: Ali M , West R L , Fiorino G , Duijvestein M , Woude C J V D , Deen W K V ,   the Initiative on Crohn’s and Colitis (ICC) European Crohn’s and Colitis Organization (ECCO)
Published: January 2025

Abstract

Background
Inflammatory bowel disease (IBD) affects quality of life and increases healthcare costs. Measuring patient outcomes for continuous quality improvement (QI) can optimize care, but resource limitations, infrastructure challenges, and strategic misalignments hinder progress. We assessed the readiness for outcome-based QI in European IBD centres at both the organizational and professional levels.

Methods
We employed a mixed-methods design, starting with a survey with follow-up interviews of IBD-specialized gastroenterologists. Dutch centres were approached through the Initiative of Crohn’s and Colitis (ICC) organization and other European centres were recruited through the European Crohn’s and Colitis Organization (ECCO). Eligible centres had a multidisciplinary care model with at least one dedicated gastroenterologist, nurse, and surgeon. Participants completed a web-based survey covering team characteristics, outcome-based monitoring for QI, resources, and attitudes toward outcome-based QI. Quantitative data were analysed using descriptive statistics, and follow-up interviews are ongoing.

Results
Of the 42 IBD centres surveyed, 69% were in the Netherlands (Figure 1). After exclusions, 36 centres were analysed (Table 1), mostly non-academic hospitals (58%) with 500-800 beds. Monitoring practices varied, with 25% monitoring outcomes annually, 25% monitoring outcomes biannually, or 28% more frequently, while 22% did not monitor outcomes. Manual or hybrid EHR data extraction was common, with few using fully automated methods. Doctors (100%) and specialized nurses (96%) consistently engaged in data discussions. Non-academic centres involved more data managers (53%) and patients (65%) than academic hospitals. Doctors led discussions in most cases (82%), particularly in academic centres (91%), with significant nurse involvement (64%). Non-academic centres had diverse leadership, including data managers (47%) and occasional patient involvement (12%). Frequently monitored outcomes included medication use (71%), clinician-reported measures (61%), healthcare utilization data (57%) and patient-reported outcomes (50%). Most centres (68%) had implemented 2-3 QI initiatives in the past year, with 48% regularly assessing their effectiveness, and most respondents recognized the value of outcome monitoring for providers and patients.

Conclusion
Outcomes monitoring is seen as an approach for QI in IBD care, yet practices varied across centres. Academic centres monitor outcomes more frequently and rely on care professionals to lead discussions, whereas non-academic centres often rely on data managers. These differences highlight the need for standardization in monitoring practices and team roles to support consistent, outcome-based QI across Europe.

References
1.Putera I. Redefining health: Implication for value-based healthcare reform. Cureus. 2017.
2.Porter ME. What is value in health care? New England Journal of Medicine. 2010;363(26):2477–81. doi:10.1056/nejmp1011024
3.Kim AH, Roberts C, Feagan BG, Banerjee R, Bemelman W, Bodger K, et al. Developing a standard set of patient-centred outcomes for inflammatory bowel disease—an international, cross-disciplinary consensus. Journal of Crohn’s and Colitis. 2017;12(4):408–18. doi:10.1093/ecco-jcc/jjx161
4.van Linschoten RC, Visser E, Niehot CD, van Der Woude CJ, Hazelzet JA, van Noord D, West RL. Systematic review: societal cost of illness of inflammatory bowel disease is increasing due to biologics and varies between continents. Alimentary pharmacology & therapeutics. 2021 Aug;54(3):234-48.
5.van Veghel D, Daeter EJ, Bax M, Amoroso G, Blaauw Y, Camaro C, et al. Organization of outcome-based quality improvement in Dutch Heart Centres. European Heart Journal - Quality of Care and Clinical Outcomes. 2019.
6.van Schie P, van Bodegom-Vos L, Zijdeman TM, Nelissen RG, Marang-van de Mheen PJ. Effectiveness of a multifaceted quality improvement intervention to improve patient outcomes after total hip and knee arthroplasty: A registry nested cluster randomised controlled trial. BMJ Quality & Safety. 2022;32(1):34–46.
7.Fiorino G, Lytras T, Younge L, Fidalgo C, Coenen S, Chaparro M, et al. Quality of care standards in inflammatory bowel diseases: A European crohn’s and colitis organization [ECCO] position paper. Journal of Crohn’s and Colitis.
8.Mair FS, May C, O’Donnell C, Finch T, Sullivan F, Murray E. Factors that promote or inhibit the implementation of e-health systems: An explanatory systematic review. Bulletin of the World Health Organization. 2012;90(5):357–64.
9.Lilford RJ, Foster J, Pringle M. Evaluating ehealth: How to make evaluation more methodologically robust. PLoS Medicine. 2009;6(11).
10.Weiner BJ. A theory of organizational readiness for change. Handbook on Implementation Science. 2020;:215–32.