Poor Documentation of Inflammatory Bowel Disease Quality Measures in Academic, Community, and Private Practice.
OBJECTIVE
Quality measures are used to standardize health care and monitor quality of care. In 2011, the American Gastroenterological Association established quality measures for inflammatory bowel disease (IBD), but there has been limited documentation of compliance from different practice settings.


METHODS
We reviewed charts from 367 consecutive patients with IBD seen at academic practices, 217 patients seen at community practices, and 199 patients seen at private practices for compliance with 8 outpatient measures. Records were assessed for IBD history, medications, comorbidities, and hospitalizations. We also determined the number of patient visits to gastroenterologists in the past year, whether patients had a primary care physician at the same institution, and whether they were seen by a specialist in IBD or in conjunction with a trainee, and reviewed physician demographics. A univariate and multivariate statistical analysis was performed to determine which factors were associated with compliance of all core measures.


RESULTS
Screening for tobacco abuse was the most frequently assessed core measure (89.6% of patients; n = 701 of 783), followed by location of IBD (80.3%; n = 629 of 783), and assessment for corticosteroid-sparing therapy (70.8%; n = 275 of 388). The least-frequently evaluated measures were pneumococcal immunization (16.7% of patients; n = 131 of 783), bone loss (25%; n = 126 of 505), and influenza immunization (28.7%; n = 225 of 783). Only 5.8% of patients (46 of 783) had all applicable core measures documented (24 in academic practice, none in clinical practice, and 22 in private practice). In the multivariate model, year of graduation from fellowship (odds ratio [OR], 2.184; 95% confidence interval [CI], 1.522-3.134; P < .001), year of graduation from medical school (OR, 0.500; 95% CI, 0.352-0.709; P < .001), and total number of comorbidities (OR, 1.089; 95% CI, 1.016-1.168; P = .016) were associated with compliance with all core measures.


CONCLUSIONS
We found poor documentation of IBD quality measures in academic, clinical, and private gastroenterology practices. Interventions are necessary to improve reporting of quality measures.
Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: jfeuerst@bidmc.harvard.edu.
Joseph D
JD
Feuerstein
Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Natalia E
NE
Castillo
Department of Medicine, Mt Auburn Hospital, Harvard Medical School, Boston, Massachusetts.
Sana S
SS
Siddique
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Jeffrey J
JJ
Lewandowski
Rockford Gastroenterology Associates, Rockford, Illinois.
Kathy
K
Geissler
Gastroenterology Service, Dr. José Eleuterio González University Hospital, Monterrey, Nuevo León, Mexico.
Manuel
M
Martinez-Vazquez
University of Illinois at Chicago College of Medicine, Rockford, Illinois; Rockford and Rockford Gastroenterology Associates, Rockford, Illinois.
Chandrashekhar
C
Thukral
Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Daniel A
DA
Leffler
Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Adam S
AS
Cheifetz
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D019983:Guideline Adherence; D006302:Health Services Research; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011331:Private Practice; D015980:Public Health Practice; D055815:Young Adult
AGA; Crohn’s Disease; Guidelines; Outcome; Ulcerative Colitis