Appropriateness of care in Inflammatory Bowel Diseases
Appropriateness of care is an essential element of high quality care, but the translation of the science of appropriateness into actual care is lagging behind. Among the fields where initial work has been done in evaluating appropriateness of care is inflammatory bowel disease (IBD), yet very little is known about the actual appropriateness of care for IBD patients. We will take advantage of the experience, expertise and data of a large national cohort of IBD (Swiss IBD Cohort Study – SIBDCS) to study the level of appropriate and inappropriate care and to evaluate mechanisms which influence appropriateness. This will be the main focus of the present project. Appropriateness of care is traditionally determined from the purely medical perspective. Yet, equally important is the patient point of view and it is essential that those developing criteria for appropriateness of care, evaluating risk and benefit to the patient, can ensure that the risks and benefits they are considering are those most important to patients themselves. Finally, the fundamental question of whether the provision of appropriate care actually leads to improved outcome has hardly been addressed in previous studies.
Objectives. This project is aimed at addressing important gaps concerning the adherence, acceptability and applicability of criteria for evaluating appropriateness of care, and specifically the treatment of patients suffering from IBD. Objectives are: (A) to assess the degree of appropriate and inappropriate care in a large national cohort of IBD patients and its impact on patient outcomes; (B) to assess the perceptions of relevance and acceptability of criteria for evaluating appropriateness of care to specialists who are called upon to apply them and to patients whose care is being evaluated; to study and compare how specialists or patients do prioritize outcomes associated with appropriateness of care.
Methods. A. To document the level of appropriate and inappropriate care for IBD patients we will apply the criteria for appropriateness of care we recently developed to the patients enrolled in the Swiss IBD Cohort Study (SIBDCS). We will categorize patient treatments according to appropriateness and analyze the determinants of appropriate care related to patients, treatments, physicians and the care environment, and assess patients’ outcomes. Outcomes to be evaluated are quality of life, satisfaction with and adherence to treatment, disease exacerbations (flares), hospitalization, surgery and treatment changes. B. Acceptance of and adherence to criteria for the appropriateness of care, as well as outcomes prioritizations, will be assessed by submitting to a sample of practicing gastroenterologists, clinical scenarios of relevant and common indications for treatment of IBD and their related degree of appropriateness. To complement this theoretical level, a sample of gastroenterologists will be asked to consult over a 4-week period, and for each new decision related to IBD, the criteria developed by two expert panels for the treatment of IBD and indicate their agreement with the criteria and/or reasons for disagreement. Patients’ perspectives on, and weightings of potential benefits deriving from, or risks related to treatments for IBD will be assessed and compared to similar perspectives from clinicians.
Expected results and importance. This study will help answer practical and important questions and address previously unstudied aspects of how to provide high quality care.