Inflammatory Bowel Disease Quality Assurance Initiative

The Pediatric Gastroenterology Division (PED-GI-WR) at Walter Reed National Military Medical Center (WRNMMC) proposes the initiation of its participation in Improve Care Now (ICN), the only quality assurance program designed to bring standardization and Improved healthcare outcomes for children suffering from Inflammatory Bowel Disease (IBD).

The PED-GI-WR division at WRNMMC is responsible for the care of over 370 patients under 21 years of age with IBD in the National Capital Area (NCA). In addition, the Military Health System (MHS) is responsible for well over 5500 such patients. Currently Military Treatment Facilities (MTFs) caring for children with these conditions have no participation in the nationwide ICN network, the only quality assurance initiative designed specifically for children with Inflammatory Bowel Disease (IBD) to bring standardization and improved healthcare outcomes for this vulnerable population of children. ICN is a provider driven initiative that seeks to establish evidence based standards in the care of children with IBD based on analysis of the population based clinical data. There are several valuable goals for the MHS to achieve with this program:

  1. It helps the MHS achieve three of the four goals of the Quadruple Aim (population health, positive patient experience and control of per capita costs) through Quality Assurance directed at achieving improved outcomes.
  2. It assists the Pediatric gastroenterology in measuring their performance in care against the ONLY national benchmark for this condition.
  3. It supports the Pediatric gastroenterologists’ need to maintain their board certification as the ICN program fulfills the American Board of Pediatrics Maintenance of Certification part 4 (Performance In Practice) requirement.

JUDGING CRITERIA Innovativeness: The innovativeness of this project is reflected in the simple concept that systematic and careful analysis of population based clinical data should drive greater standardization of practice in the care of chronically ill children. This is not a particularly “new” concept as it has been applied in such initiatives as Pediatric Oncology Group and the Cystic Fibrosis Foundation, both organizations that providers in MTFs participate at the benefit of their patients. Indeed this sort of collaborative approach to chronic illness has become the standard of care in medicine. Cost Effectiveness: The initial costs of the program include:

  1. Participation fee for the MTF: $18,500/year (ICN leadership is willing to include ALL MTFs participating in this project for one fee assuming it is rolled out to other MTFs).
  2. Personnel: a. 0.7 FTE research coordinator: $110,000 for contract nurse (person who will record data and “push” it to ICN database, update charts, assure ICN protocols are followed, etc.) X 0.7 FTE= $77,000 b. 0.2 FTE MD champion (internal resources) c. 0.2 FTE Nurse champion: $110,000 X 0.2 FTE= 22,000
  3. Travel cost and lodging for these individual to semi-annual meeting in Chicago (air and lodging for 3 days). $9000/year
  4. Therefore total costs per year would be about $117,500. The ROI would be based on improved outcomes, decrease waste of resources and improved patient satisfaction for those suffering with IBD. Since 2008, when ICN started, they have demonstrated an increase in patients in remission from 50% to 75%, children with poor growth has decreased by 60% and children on prednisone has decreased by 30%. Currently there are 48 civilian centers participating in ICN, none of which are in the State of Maryland. Ease of Implementation: The challenges in implementation will depend primarily on source of funding and on the ability to satisfy DOD information sharing requirements. Since the data collection is strictly for performance improvement, this project would be considered as part of the DOD Medical Quality Assurance Program and therefore restricted from outside organizations based on Freedom of Information Act requirements. The shared data satisfies HIPPA encryption requirements. For these reasons we expect our relationship with ICN will satisfy MHS Legal Council.
    Scalability: Once this project begins it can easily be scaled to any DOD MTF where children with IBD are seen. Tri-Service: This is a Tri-service project.

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