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©2012 Baishideng Publishing Group Co.
World J Gastroenterol. Mar 14, 2012; 18(10): 1085-1092
Published online Mar 14, 2012. doi: 10.3748/wjg.v18.i10.1085
Published online Mar 14, 2012. doi: 10.3748/wjg.v18.i10.1085
Characteristics of measures included in the framework | Properties of the models included in the framework | ||||||
Quality measure | Definition of measure | Data source and data collection | Operational definition of measure | Purposes for the measure adapted from Behn | Quality dimensionaccording to the clinical value compass | Quality components as part of the quality model of Donabedian | |
Patient data | Diagnosis | Inflammatory bowel disease | Local gastro registry | Crohn’s disease and ulcerative colitis | Control, evaluation | Clinical dimension | Outcome |
Gender | Sex | Local gastro registry | female:male | Control, learning | Clinical dimension | Structure | |
Age | Local gastro registry | Age [mean (SD)] range | Control, learning | Clinical dimension | Structure | ||
Disease duration | Début year | Local gastro registry | Years since time of diagnosis [mean (SD)] range | Control, evaluation | Clinical dimension | Outcome | |
Laboratory measures | Hemoglobin | Blood sample enabling detection of anemia associated with chronic disease, blood loss, or iron deficiency | Local gastro registry Tests were performed at the nearest primary care center and reported electronically | Cut-off points were defined as: mean (SD) normal ≥ 120 g/L, anemia 100-119 g/L severe anemia < 100 g/L missing | Control, evaluation | Clinical dimension | Outcome |
Medication | Prescribed medicine | Currently prescribed preventive medication | Local gastro registry | Prescribed medication: 5-ASA cortisone immunosuppressive anti-TNF-α no medication | Control, evaluation | Clinical dimension | Process |
Surgical interventions | Incidence of surgery | Surgical interventions associated with IBD | ERS, searched for ICD codes for surgical interventions and IBD once a year | Type and numbers of surgical interventions: colectomy hemicolectomy loop ileostomy perianal/fistula/ stricture incision revision abdominal scar | Evaluation | Clinical and cost dimension | Process |
Tumor incidence | Incidence of gastrointestinal tumors associated with IBD | Data from the national tumor registry retrieved once a year | Number and type of intestinal tumors associated with IBD according to diagnosis in records as ICD code | Evaluation | Clinical and cost dimension | Outcome | |
Quality of life | The Short Health Scale, SHS | SHS is a health related quality of life questionnaire consisting of four questions graded on a 6 point Likert scale. | Local gastro registry | Percent scoring 1 to 3 representing that the goal of the care was reached symptoms functioning worry wellbeing | Evaluation | Functional dimension | Outcome |
Access to care | Waiting time | Referral from primary to secondary care | Local administrative data base | Number of days from the referral being sent from the primary care physician until the patient received a scheduled consultation at the outpatient clinic | Motivation, budget, learning, evaluation, promotion | A proxy for the satisfaction dimension | Process and outcome |
Waiting time for known patients | An acute visit is used for an urgent need of assessment due to deteriorating disease | Local administrative data base | The clinic’s ability to offer an acute visit within two days after contact for known IBD patients | Motivation, budget, learning, evaluation, promote | A proxy for the satisfaction dimension | Process | |
Contact route (before being admitted to hospital) | The place for the decision to admit the patient for inpatient care, i.e. either at the ER or the outpatient clinic | ERS Contact route was decided after finding indicators such as: where the note was written, if the note was written by an on call colleague or a gastroenterologist | The ERS was searched to find out where the decision was either at the ER or from the outpatient clinic | Learning | Cost and a proxy for the satisfaction dimension | Process | |
Hospitalization | Hospitalization | Individual and total numbers of admittances for IBD patients | ERS was searched for ICD codes and national data was retrieved from the National Board of Health and Welfare | ERS documented ICD code for IBD and hospitalisation | Motivation, budget, evaluation | Cost dimension | Process and outcome |
Quality measures from 2008 | Crohn’s disease | Ulcerative colitis | |
Patient data | Diagnosis | 194 | 261 |
Gender | |||
Female:male | 44%:56% | 42%:58% | |
Age (yr) | |||
Mean (SD) | 53 (± 15) | 51 (± 15) | |
Range | 18-90 | 20-91 | |
Disease duration | |||
Years since time of diagnosis | |||
Mean (SD) | 20 (± 13) | 14 (± 10)) | |
Range | 0-58 | 0-53 | |
Laboratory measures | Hemoglobin | ||
Mean (SD) | 140 (± 12) | 143 (± 13) | |
Normal ≥ 120 g/L | 95% | 96% | |
Anemia 100-119 g/L | 4% | 4% | |
Severe anemia < 100 g/L | < 1% | 0 | |
Missing | 16% | 17% | |
Medication | Prescribed medicine | ||
5-ASA | 43% | 56% | |
Cortisone | 16% | 4% | |
Immunosuppressant | 34% | 12% | |
Anti-TNF-α | 8% | 2% | |
No medication | 31% | 40% | |
Surgical | Incidence of surgery | ||
interventions | Type and numbers of surgical interventions: | ||
Colonectomy | 3 | ||
Hemicolectomy | 1 | 1 | |
Loop ileostomy | 1 | ||
Perianal/fistula/stricture incision | 3 | 1 | |
Revision abdominal scar | 1 | ||
Tumor incidence | |||
Number and type of intestinal tumors associated with IBD according to diagnosis in records as ICD code | 0 | 0 | |
Quality of life | The Short Health Scale, SHS | ||
Percent scoring 1 to 3 representing that the goal of the care was reached | |||
symptoms | 95% | 98% | |
functioning | 88% | 95% | |
worry | 91% | 94% | |
wellbeing | 97% | 96% | |
Access to care | Waiting time | ||
Number of days from the referral being sent from the primary care physician until the patient received a scheduled consultation at the outpatient clinic | < 3 wk | < 3 wk | |
Waiting time for known patients | |||
The clinic’s ability to offer an acute visit within two days after contact for known IBD patients | < 2 d | < 2 d | |
Contact route (before being admitted to hospital) | |||
The ERS was searched to find out where the decision was either at the ER or from the outpatient clinic | 50%/50% | 50%/50% | |
Hospitalization | Hospitalization | ||
ERS documented ICD code for IBD and hospitalisation | 29 | 17 |
- Citation: Rejler M, Tholstrup J, Elg M, Spångéus A, Gäre BA. Framework for assessing quality of care for inflammatory bowel disease in Sweden. World J Gastroenterol 2012; 18(10): 1085-1092
- URL: https://www.wjgnet.com/1007-9327/full/v18/i10/1085.htm
- DOI: https://dx.doi.org/10.3748/wjg.v18.i10.1085