title: Improved population-based care: Implementing patient-and demand-directed care for inflammatory bowel disease and evaluating the redesign with a population-based registry.
abstract: The gastroenterology unit at the Höglands Hospital in Eksjö is responsible for the care of all 466 patients with inflammatory bowel disease (IBD) in a geographic area including approximately 115,000 inhabitants. In 2000, the frustration over an inadequate traditional outpatient clinic inspired us to redesign our outpatient unit to become more patient and demand directed. The redesign included the following: A direct telephone line for patients to a specialized nurse, available during working hours; appointments were scheduled in accordance with expected needs, and emergency appointments were available daily; traditional follow-ups of IBD patients were replaced by an annual telephone contact with a specialized nurse; the team agreed on a patient-centered value base for its work, and the redesign was monitored using clinical outcome measures reflecting 4 dimensions (see parentheses below) of the care in a "Value compass"; quality of life (functional) and routine blood samples (clinical) were followed yearly and collected in a computerized IBD registry together with basic information about the patients; access and waiting lists together with patient satisfaction (satisfaction) are followed regularly; and ward utilization (financial) was registered. Our study shows that the new design offers a more efficient outpatient clinic in which waiting lists are markedly reduced although production rates remains the same. Utilization data show a significant decrease in comparison with national data, showing that the new care is economically favorable. The clinical results regarding anemia frequency in the IBD population are highly comparable with or even better than those found in the literature. We also show good results regarding quality of life where more than 88% of patients achieve set goals. In conclusion, our new patient- and demand-directed care seems to be more efficient and with clinical and quality-of-life results remaining on a high standard.
authors.affiliation: Department of Medicine, Höglands Hospital in Eksjö, Sweden. martin.rejler@lj.se
authors.forename: Martin
authors.initials: M
authors.lastname: Rejler
authors.forename: Anna
authors.initials: A
authors.lastname: Spångéus
authors.forename: Jörgen
authors.initials: J
authors.lastname: Tholstrup
authors.forename: Boel
authors.initials: B
authors.lastname: Andersson-Gäre
mesh_terms: D002908:Chronic Disease; D006297:Health Services Accessibility / Q000458:organization & administration; D006301:Health Services Needs and Demand; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000628:therapy*; D011787:Quality of Health Care / Q000458:organization & administration*; D012042:Registries; D013222:State Medicine; D013548:Sweden