scholarly journals Utilization of an Electronic Medical Record–integrated Dashboard Improves Identification and Treatment of Anemia and Iron Deficiency in Pediatric Inflammatory Bowel Disease

2020 ◽  
Author(s):  
Jessica Breton ◽  
Char M Witmer ◽  
Yuchen Zhang ◽  
Maura Downing ◽  
Jamie Stevenson ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Quality Improvement ◽  
Iron Deficiency ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Bowel Disease ◽  
Care Pathway ◽  
Evidence Based ◽  
Inflammatory Bowel ◽  
Evidence Based Care

Abstract Background Iron deficiency (ID) and anemia are one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD), usually complicating the course both in ulcerative colitis and Crohn’s disease. Despite their high prevalence and significant impact on patients, this particular aspect is still underestimated by clinicians. Although guidelines have been recently published to address this problem, these recommendations do not address pediatric specific concerns and do not provide guidance as to how implement these guidelines in clinical practice. The aims of this quality improvement (QI) initiative were to improve the rates of detection and treatment of anemia in children with IBD. Methods After the creation of a multidisciplinary team of skateholders in IBD and anemia, we launched a multifaceted QI strategy that included the development of a pediatric evidence-based care pathway, utilization of an electronic medical record (EMR)-integrated dashboard to track patients, and generation of an automated provider-based monthly report. Data were collected and graphed into statistical process control charts. Results These key strategies resulted in improved rates of ID screening from 31.7% to 63.6%, in increased treatment rates from 38.2% to 49.9%, and in decreased prevalence of anemia from 35.8% to 29.7%, which was reflected by a greater decline in patients with quiescent disease. Conclusions Quality improvement strategies incorporating the creation of a pediatric evidence-based care pathway with an EMR-supported electronic dashboard were the foundation of a successful intervention in the management of ID and anemia in pediatric IBD. Our positive results demonstrate the potential of QI initiatives using automated technology to assist clinicians in their commitment to provide evidence-based IBD care and enhance patient outcomes.

27 UTILIZATION OF AN ELECTONIC MEDICAL RECORD (EMR)-INTEGRATED DASHBOARD IMPROVES IDENTIFICATION AND TREATMENT OF IRON DEFICIENCY IN PEDIATRIC INFLAMMATORY BOWEL DISEASE

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S58-S58
Author(s):  
Jessica Breton ◽  
Zhang Yuchen ◽  
Trusha Patel ◽  
Janine McDermott ◽  
Jamie Stevenson ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Iron Deficiency ◽  
Medical Record ◽  
Bowel Disease ◽  
Clinical Pathway ◽  
Clinical Decision ◽  
Deficiency Anemia ◽  
Treatment Rate ◽  
Inflammatory Bowel ◽  
Online Availability

Abstract Background Anemia is frequently encountered in inflammatory bowel disease (IBD) with studies reporting an even greater prevalence among children (16–72%) than adults (4–67%) at any given time during disease course. Anemia is commonly a result of chronic iron deficiency (ID) and inflammation, with the two conditions often overlapping. Many studies have shown that gastroenterologists underecognize and undertreat these conditions. Moreover, there are currently no pediatric-specific guidelines. To align clinical practice with adult guideline recommendations and evidence-based publications, we developed a quality improvement (QI) initiative incorporating an algorithmic framework for recognition and treatment of iron deficiency anemia (IDA) in pediatric IBD. Methods The goals were twofold: improvement in 1) detection and 2) treatment rates of IDA in IBD patients. A multifaceted approach with a series of plan-do-study-act (PDSA) cycles was executed: 1. Public review of our current performance of anemia screening and treatment with all divisional providers (n=60) (11/2017), 2. Development of a new divisional clinical pathway for screening and treatment of IDA in patients with IBD (01/2018), 3. Educational sessions (02-04/2018), 4. Creation of an Epic order set and patient and family education (PFE) (02/2018), 5. Online availability of our pathway (11/2018), and 6. Utilization of an electronic medical record (EMR)-integrated dashboard to track our outcome metrics. A designated coordinator identified patients in the EMR and sent monthly reports to providers based on our automated dashboard which captured the percentage of patients with ordered hemoglobin (Hb) and ferritin, percentage of patients with anemia and/or iron deficiency, and percentage of patients with ordered iron therapy. Baseline data from July 2016 were compared to data after pathway implementation. Results In the pre-intervention period (July 2016-November 2017), 73.5% of our outpatient IBD population had a Hb ordered, with anemia prevalence of 36.3%. Only a minority of patients with anemia were being screened for ID (19.3%). Iron supplementation was prescribed in 38.1% of patients with documented anemia. Following the implementation of this QI initiative, rate of patients with biannual Hb testing completed increased to 80.1%, while prevalence of anemia decreased to 32.1%. Significant improvement was observed with screening and treatment rate increasing to 43.1% and 50.4% respectively by July 2019 as shown in Fig. 1–2. Notably, patients with moderate to severe anemia improved significantly from 48.7% to 62.1%. Conclusion ID and anemia are commonly underdiagnosed and undertreated in children with IBD. An evidence and expert based pathway combined with implementation of provider-based monthly reports using the EMR to support clinical decision may help increase screening and intervention and decrease rates of anemia prevalence. https://www.chop.edu/clinical-pathway

scholarly journals Long-Term Effectiveness of Oral Ferric Maltol vs Intravenous Ferric Carboxymaltose for the Treatment of Iron-Deficiency Anemia in Patients With Inflammatory Bowel Disease: A Randomized Controlled Noninferiority Trial

2021 ◽  
Author(s):  
Stefanie Howaldt ◽  
Eugeni Domènech ◽  
Nicholas Martinez ◽  
Carsten Schmidt ◽  
Bernd Bokemeyer
Keyword(s):  
Inflammatory Bowel Disease ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Primary Endpoint ◽  
Bowel Disease ◽  
Deficiency Anemia ◽  
Ferric Carboxymaltose ◽  
Inflammatory Bowel ◽  
Intent To Treat

Abstract Background Iron-deficiency anemia is common in inflammatory bowel disease, requiring oral or intravenous iron replacement therapy. Treatment with standard oral irons is limited by poor absorption and gastrointestinal toxicity. Ferric maltol is an oral iron designed for improved absorption and tolerability. Methods In this open-label, phase 3b trial (EudraCT 2015-002496-26 and NCT02680756), adults with nonseverely active inflammatory bowel disease and iron-deficiency anemia (hemoglobin, 8.0-11.0/12.0 g/dL [women/men]; ferritin, <30 ng/mL/<100 ng/mL with transferrin saturation <20%) were randomized to oral ferric maltol 30 mg twice daily or intravenous ferric carboxymaltose given according to each center’s standard practice. The primary endpoint was a hemoglobin responder rate (≥2 g/dL increase or normalization) at week 12, with a 20% noninferiority limit in the intent-to-treat and per-protocol populations. Results For the intent-to-treat (ferric maltol, n = 125/ferric carboxymaltose, n = 125) and per-protocol (n = 78/88) analyses, week 12 responder rates were 67% and 68%, respectively, for ferric maltol vs 84% and 85%, respectively, for ferric carboxymaltose. As the confidence intervals crossed the noninferiority margin, the primary endpoint was not met. Mean hemoglobin increases at weeks 12, 24, and 52 were 2.5 vs 3.0 g/dL, 2.9 vs 2.8 g/dL, and 2.7 vs 2.8 g/dL with ferric maltol vs ferric carboxymaltose. Treatment-emergent adverse events occurred in 59% and 36% of patients, respectively, and resulted in treatment discontinuation in 10% and 3% of patients, respectively. Conclusions Ferric maltol achieved clinically relevant increases in hemoglobin but did not show noninferiority vs ferric carboxymaltose at week 12. Both treatments had comparable long-term effectiveness for hemoglobin and ferritin over 52 weeks and were well tolerated.

414 REDUCTION OF CHRONIC STEROID USE IN PATIENTS DISCHARGED FOR INFLAMMATORY BOWEL DISEASE FLARES: A 28-MONTH QUALITY IMPROVEMENT STUDY

2021 ◽  
Vol 160 (6) ◽  
pp. S-84
Author(s):  
Chung Sang Tse ◽  
Yousef Elfanagely ◽  
Joshua R. Tanzer ◽  
Albert Manudhane ◽  
Abbas Rupawala ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Quality Improvement ◽  
Bowel Disease ◽  
Steroid Use ◽  
Inflammatory Bowel
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