2019 Felch Award for Outstanding Research in Continuing Education: A System-Level Quality Improvement Initiative in Inflammatory Bowel Disease (IBD)

Submitted by Kathleen Moreo, RN, BC, BSN, BHSA, CCM, CDMS

In order to support healthcare professionals in achieving national goals of quality-driven and value-based healthcare, the U.S. gastroenterology community has developed, implemented and assessed national quality measures for the care of patients with inflammatory bowel disease (IBD). However, recent reports have revealed suboptimal rates of compliance with IBD quality measures, with leading experts calling for an expansion of established quality improvement (QI) principles and measures to address unmet treatment needs for IBD patients.

Inspired by the challenges of advancing and extending QI principles and practices in IBD care, Weill Cornell called upon PRIME Education’s research and education teams to assist in improving patient assessment and treatment practices, as well as team-based workflow processes that could improve quality measures.

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PRIME designed a research-informed QI education program that, once approved by the institutional review board, was implemented at the Weill Cornell Medicine system in New York City, through the educational co-support of Takeda Pharmaceuticals, U.S.A., and AbbVie, Inc. Program participants comprised gastroenterologists attending or affiliated with the Jill Roberts Center for IBD at Weill Cornell Medicine, as well as their clinical teams of nurse practitioners, physician assistants, pharmacists and administrative staff.

Participants completed baseline and post-program surveys designed to assess QI- and IBD-related knowledge, competencies, attitudes, values and self-reported practice patterns at the individual and team levels. In addition, the electronic medical records of 200 IRB patients were reviewed to examine real-world performance and alignment on evidence-based assessment practices and treatment decisions. Seminal temporal-event measures were included. The chart audits, surveys and qualitative data collected during multiple feedback periods were used as benchmarks to assess the impact of team-led action plans and interventions, supported by PRIME. Notably, several of the key measures evaluated have not been previously investigated in IBD QI initiatives, according to the literature.

Analysis of the survey and EMR data informed our designs of gap-targeted QI educational interventions involving strategically timed live audit-and-feedback activities that were organized in plan-do-study-act (PDSA) cycles. Moreover, accredited online activities were deployed to promote both sustainability for the system and scalability to a wider audience of clinicians. Findings from this research-informed CE project will be submitted for publication to advance the efforts and solutions of the Weil Cornell team and scale up lessons learned.

Significant Contributions

As a result of this IBD QI initiative, valuable advances were made across various system departments of the Weill Cornell Medical system, where interdisciplinary teams identified delays in IBD patient treatment and the underlying root causes and obstacles causing them. Attesting to this positive impact on the Weill Cornell Medicine system, this initiative was selected for presentation at the annual Weill Cornell Medicine Quality Improvement Project (QIPS) Conference in 2018. The findings were not only shared with the GI/IBD team, but achieved system scalability resulting in new collaborations with the system’s specialty pharmacy department, resulting in improved processes to achieve earlier and more time access to appropriate therapies for IBD patients in the Weill Cornell system.

In its innovation, this QI initiative establishes a continuing education model for incorporating measures of healthcare quality that complement and advance conventional quality measures, which have largely focused on preventive care and safety. Novel educational needs are emerging as healthcare professionals confront major challenges in achieving high-quality, value-based healthcare, with new programs needed to address hurdles in reaching benchmarks for evidence-based clinical practice and overcoming significant workflow and administrative barriers.

Acknowledgement

Independent medical education support for this initiative was provided by AbbVie, Inc. and Takeda Pharmaceuticals, USA.

References

Moreo K, Sapir T, Carter J, Simone LC, Greene L, Fajardo K, Faulkner M, Shklovskaya J. A Quality Improvement Initiative in Inflammatory Bowel Disease at Weill Cornell Medicine and The Jill Roberts Center for Inflammatory Bowel Disease (IBD). Alliance for Continuing Education in the Health Profession; January 2019.

Sapir T, Carter J, Cohen-Mekelburg S, Chabouni F, Reich J, Krichevsky B, Gold S, Crawford CV, Scherl E. A QI Educational Initiative to Reduce Relays and Improve Access to Inflammatory Bowel Disease Treatment in Academic and Community Settings. Poster Presentation at Weill Cornell Medicine. New York, NY; May 23, 2018.

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