Approaches to improve quality of care in inflammatory bowel diseases

Table 1 American gastroenterology association inflammatory bowel disease performance measures[16]

Performance measures
IBD characteristics
	Type
	Anatomic location
	Activity
Preventive care
	Corticosteroid sparing therapy
	Bone loss assessment
	Influenza immunization
	Pneumococcal immunization
	Smoking screening and cessation assessment
Testing
	Latent tuberculosis testing prior to anti-TNF therapy
	Assessment for Hepatitis B prior to anti-TNF therapy
Inpatient care
	Clostridium difficile testing in patients with new onset diarrhea
	Venous thromboembolism prophylaxis

IBD: Inflammatory bowel disease; TNF: Tumor necrosis factor.

Table 2 Crohn’s and Colitis Foundation of America inflammatory bowel disease process measures[17]

Process measures
Treatment
	If anti-TNF therapy is considered, then test for tuberculosis with skin testing or interferon gamma release assay
	If anti-TNF therapy is considered, then assess for latent hepatitis B virus
	Consider steroid sparing agent, if steroids needed at 10 mg (of more) daily for > 16 wk
	Test for Clostridium difficile if a patient presents with new symptoms of diarrhea
	If planning to start 6-mercaptopurine or azathioprine, then test for thiopurine methyltransferase and dose accordingly
	If a patient is hospitalized with severe colitis and does not improve after 3 d of IV steroids, flexible sigmoidoscopy with biopsies should be performed to check for CMV infection and surgery consulted
Surveillance
	If a patient with UC has low grade dysplasia in flat mucosa, then procto-colectomy or repeat surveillance in 6 mo should be offered
	If a patient has extensive UC or Crohn’s disease involving the colon for 8-10 yr, then surveillance colonoscopy should be performed every 1-3 yr
Health maintenance
	If a patient is on immunosuppressive therapy, then vaccinations for influenza and pneumococcus should be offered, as well as education regarding avoidance of live vaccines
	If a patient has Crohn’s disease, smoking status should be assessed and smoking cessation recommended

TNF: Tumor necrosis factor; UC: Ulcerative colitis.