title: Improved outcomes in a quality improvement collaborative for pediatric inflammatory bowel disease.
abstract: OBJECTIVE
  Unintended variation in the care of patients with Crohn disease (CD) and ulcerative colitis (UC) may prevent achievement of optimal outcomes. We sought to improve chronic care delivery and outcomes for children with inflammatory bowel disease by using network-based quality improvement methods.
  
  
  METHODS
  By using a modified Breakthrough Series collaborative structure, 6 ImproveCareNow Network care centers tested changes in chronic illness care and collected data monthly. We used an interrupted time series design to evaluate the impact of these changes.
  
  
  RESULTS
  Data were available for 843 children with CD and 345 with UC. Changes in care delivery were associated with an increase in the proportion of visits with complete disease classification, measurement of thiopurine methyltransferase (TPMT) before initiation of thiopurines, and patients receiving an initial thiopurine dose appropriate to their TPMT status. These were significant in both populations for all process variables (P < .01) except for measurement of TPMT in CD patients (P = .12). There were significant increases in the proportion of CD (55%-68%) and UC (61%-72%) patients with inactive disease. There was also a significant increase in the proportion of CD patients not taking prednisone (86%-90%). Participating centers varied in the success of achieving these changes.
  
  
  CONCLUSIONS
  Improvements in the outcomes of patients with CD and UC were associated with improvements in the process of chronic illness care. Variation in the success of implementing changes suggests the importance of overcoming organizational factors related to quality improvement success.
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH 43205, USA. wallace.crandall@nationwidechildrens.org
authors.forename: Wallace V
authors.initials: WV
authors.lastname: Crandall
authors.forename: Peter A
authors.initials: PA
authors.lastname: Margolis
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kappelman
authors.forename: Eileen C
authors.initials: EC
authors.lastname: King
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pratt
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Boyle
authors.forename: Lynn F
authors.initials: LF
authors.lastname: Duffy
authors.forename: John E
authors.initials: JE
authors.lastname: Grunow
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Kim
authors.forename: Ian
authors.initials: I
authors.lastname: Leibowitz
authors.forename: Bess T
authors.initials: BT
authors.lastname: Schoen
authors.forename: Richard B
authors.initials: RB
authors.lastname: Colletti
mesh_terms: D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000628:therapy*; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D058996:Quality Improvement; D012189:Retrospective Studies; D014481:United States