ImproveCareNow: The development of a pediatric inflammatory bowel disease improvement network.
There is significant variation in diagnostic testing and treatment for inflammatory bowel disease. Quality improvement science methods can help address unwarranted variations in care and outcomes.


METHODS
The ImproveCareNow Network was established under the sponsorship of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the American Board of Pediatrics as a prototype for a model of improving subspecialty care that included three components: 1) creating enduring multicenter collaborative networks of pediatric subspecialists, 2) sharing of performance data collected in patient registries, and 3) training in quality improvement. The network began with a focus on improving initial diagnostic testing and evaluation, the classification of the severity and extent of disease, the detection and treatment of inadequate nutrition and growth, and the appropriate dosing of immunomodulator medications. Changes are based on an evidence-based model of chronic illness care involving the use of patient registries for population management, previsit planning, decision support, promoting self-management, and auditing of care processes.


RESULTS
Currently, patients are being enrolled at 23 sites. Through 2009, data have been analyzed on over 2500 patients from over 7500 visits. Initial results suggest improvements in both care processes (e.g., appropriate medication dosing and completion of a classification bundle that includes the patient's diagnosis, disease activity, distribution and phenotype, growth status, and nutrition status) and outcomes (e.g., the percentage of patients in remission).


CONCLUSIONS
These improvements suggest that practice sites are learning how to apply quality improvement methods to improve the care of patients.
Crandall
Wallace
W
Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio 43205, USA. Wallace.crandall@nationwidechildrens.org
Kappelman
Michael D
MD
Colletti
Richard B
RB
Leibowitz
Ian
I
Grunow
John E
JE
Ali
Sabina
S
Baron
Howard I
HI
Berman
James H
JH
Boyle
Brendan
B
Cohen
Stanley
S
del Rosario
Fernando
F
Denson
Lee A
LA
Duffy
Lynn
L
Integlia
Mark J
MJ
Kim
Sandra C
SC
Milov
David
D
Patel
Ashish S
AS
Schoen
Bess T
BT
Walkiewicz
Dorota
D
Margolis
Peter
P
D002648:Child; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000628:therapy*; D010372:Pediatrics / Q000592:standards*; D058996:Quality Improvement; D011787:Quality of Health Care