P-144 YI Quality Measures in Outpatient Inflammatory Bowel Disease Care: Are We Documenting Compliance?. (February 2017)

• Record Type: Journal Article
• Authors: Wilson, Farra; Bloomfeld, Richard; Green, Patrick; Dharod, Ajay
• Is Part Of: Inflammatory bowel diseases. Volume 23(2017)Supplement 1
• Publication Date: 2017-02
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1097/01.MIB.0000512662.09348.53
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract : Background: Inflammatory Bowel Disease (IBD) is a chronic condition often diagnosed at a young age without a cure, requiring a lifetime of medical care. Given this, IBD can lead to significant health, lifestyle and cost burdens to patients, their families and society. Several healthcare organizations have created performance measures to aid in establishing evidence-based standards of care in attempts to improve the quality of IBD care, and ultimately health outcomes. The Physician Quality Reporting System (PQRS) has defined 7 performance measures which apply to outpatient IBD care, including: management of patients with corticosteroid sparing therapies, documentation of risk for corticosteroid related iatrogenic bone injury, documentation of prior or administration of the influenza vaccination, documentation of prior or administration of the pneumonia vaccination, testing for latent TB before initiation of anti-tumor necrosis factor (anti-TNF) therapy, testing for hepatitis B status before initiation of anti-TNF therapy and screening and cessation interventions for tobacco abuse. The aim of this study was to assess documentation compliance with selected PQRS performance measures at one academic medical center and gastroenterologists' self-assessment of their personal compliance. Methods: Fifty IBD patient charts were randomly selected from consecutive outpatient IBD visits at our medical center from January 9, 2015 to June 30, 2016. These charts were reviewed to assess compliance levels with PQRS performance measures for outpatient IBD care, except management of corticosteroid sparing therapies. In addition, an online physician survey was conducted to anonymously assess gastroenterologists' perceived compliance with these measures. Results: Of the 50 patients, 11 met criteria for being at risk for bone loss related to steroid use. Zero of the 11 (0%) patients' charts had documentation of bone loss assessment evaluation. Thirty-six of the patients were seen during flu season and 7/36 (19.4%) of those received the influenza vaccine, refused the vaccine or had chart documentation of prior receipt of the vaccine. Only 8 of the 50 charts reviewed were patients 65 years of age or older and zero (0%) of those received the pneumonia vaccine, refused the vaccine or had chart documentation of prior receipt of the vaccine. Only 3 of the charts reviewed were within 1 year of initiation of ant-TNF therapy. Of these, 2/3 (66.7%) had documentation of testing for latent tuberculosis and 3/3 (100%) had documentation of assessment of hepatitis B virus prior to initiation of anti-TNF therapy. All 50 patients had been screened for tobacco use with 7/50 being active smokers. Of those, 2/7 (28.6%) received a tobacco cessation intervention. Seven out of 13 physicians surveyed (53.8%) felt that they often complied with the PQRS performance measures with IBD patients in the outpatient setting. However, when asked if they complied with documentation of those same performance measures, only 5/13 (38.5%) felt that they often documented their compliance. Conclusions: Documented compliance with several PQRS performance measures for outpatient IBD care is low at our medical center. Most gastroenterologists feel confident that they clinically comply with these performance measures, but often their documentation does not reflect this.