P513 Assessment of quality indicators in The Swedish Inflammatory Bowel Disease Registry (SWIBREG) for Crohn’s Disease treated with biological therapies
Xu, C.(1);Byman, V.(2);Hossain, J.(2);Storlåhls, A.(2);Hedin, C.(2);
(1)Karolinska Universtiy Hospital, Division of Upper Abdominal Diseases, Stockholm, Sweden;(2)Karolinska Universtiy Hospital, Division of Gastroenterology- Medical Unit Gastroenterology- Dermatovenereology and Rheumatology, Stockholm, Sweden; Karolinska Gut Group
Background
The development and clinical application of quality indicators (QI) for IBD are objectives of The Swedish inflammatory bowel disease registry (SWIBREG)(1). These include objective and subjective parameters aiming to standardise IBD care in Sweden(2).We aimed to evaluate QI target attainment at Karolinska University Hospital, and to identify specific patient or disease parameters associated with failure to reach QI targets.
Methods
QI targets as defined by SWIBREG were analysed in patients with Crohn´s disease undergoing treatment with biologics. A retrospective register-based study included 292 patients who received biological treatment between 2018-08-01 and 2020-01-31. Pediatric Crohn’s patients and patients with a treatment duration <6 months were excluded.
Table 1. SWIBREG quality indicators.
| Short Health Scale (SHS) | >75% with ≥1 evaluation last 18mo, >80% reporting “interfere to a moderate degree”, “interfere to a low degree” or “not at all” |
| Physician Global Assessment (PGA) | >75% with ≥1 evaluation within 18mo, >80% reporting “mild activity” or “remission”. |
| Faecal Calprotectin | >75% with ≥1 measured value last 18mo, >80% with latest value <250 µg/g. |
| Anaemia | >75% with ≥1 Hb value las 18mo, <10% of those measured anaemic. |
| Accessibility (not analysed) | >50% with ≥1 entries within last 18mo , >90% reporting ”good” or ”very good” accessibility regardless of treatment. |
Results
Faecal Calprotectin (FC) and Haemoglobin (Hb) values were registered for 80% and 86%, respectively. Anaemia prevalence was 30%. Significantly lower monitoring frequencies were observed in patients undergoing treatment with Adalimumab and patients with biological treatment duration >1 year. FC was <250 μg/g in 77% of patients. The QI target for the frequency of Short Health Scale (SHS) registration was met whereas that of Physician Global Assessment (PGA) was not. The QI target for the most recent value of both SHS and PGA were met. Only 70% of smokers, 72% of patients with biological treatment duration >1 year and 52% of adalimumab patients had a registered SHS evaluation.
Conclusion
Adalimumab treatment, treatment duration and smoking are associated with decreased frequency of registration of QIs. Efforts are needed to ensure quality of care for these groups. A lower rate of PGA monitoring may reflect a lack of capacity for physician assessments and could be complemented with “professional global assessments” by specialist IBD nurses.
References:
1. Ludvigsson JF, Andersson M, Bengtsson J, Eberhardson M, Fagerberg UL, Grip O, et al. Swedish Inflammatory Bowel Disease Register (SWIBREG) - a nationwide quality register. Scand J Gastroenterol. 2019;54(9):1089-101.
2. Berry SK, Melmed GY. Quality indicators in inflammatory bowel disease. Intest Res. 2018;16(1):43-7.