Crohn's & Colitis Australia inflammatory bowel disease audit: measuring the quality of care in Australia

Abstract

Background:Australia has among the highest prevalence of Crohn disease and ulcera-tive colitis in the world. Management of the chronic gastrointestinal disorders results insignificant societal costs and the standard of care is inconsistent across Australia.Aim:To audit the quality of care received by patients admitted for inflammatory boweldisease (IBD) across Australia against national IBD standards.Methods:A retrospective cross-sectional survey and clinical audit was undertakenassessing organisational resources, clinical processes and outcome measures. This studywas conducted in Australian hospitals that care for inpatients with Crohn disease orulcerative colitis. The main outcome measures were adherence to national IBD stan-dards and comparison of quality of care between hospitals with and without multi-disciplinary IBD services.Results:A total of 71 hospitals completed the organisational survey. Only one hospitalhad a complete multidisciplinary IBD service and 17 had a partial IBD service (IBDnurse, helpline and clinical lead). A total of 1440 inpatient records was reviewed from52 hospitals (mean age 37 years; 51% female, 53% Crohn disease), approximately26% of IBD inpatient episodes over a 12-month period in Australia. These patientswere chronically unwell with high rates of anaemia (30%) and frequent readmissions(40% within 2 years). In general, care was inconsistent, and documentation was poor.Hospitals with a partial IBD service performed better in many processes and outcomemeasures: for example, 22% reduction in admissions through emergency departmentsand greater adherence to standards for safety monitoring of biological (89% vs 59%)and immunosuppressive drugs (79% vs 55%) in those hospitals than those without.Conclusion:Patients admitted to hospital suffering from IBD are young, chronicallyunwell and are subject to substantial variations in clinical documentation and quality ofcare. Only one hospital met accepted standards for multidisciplinary care; hospitals witheven a minimal IBD service provided improved care.