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Framework for assessing quality of care for inflammatory bowel disease in Sweden
Highland Hospital, Eksjö, Sweden.
Highland Hospital, Eksjö, Sweden.
Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
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2012 (English)In: World Journal of Gastroenterology, ISSN 1007-9327, E-ISSN 2219-2840, Vol. 18, no 10, 1085-1092 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To create and apply a framework for quality assessment and improvement in care for inflammatory bowel disease (IBD) patients. less thanbrgreater than less thanbrgreater thanMETHODS A framework for quality assessment and improvement was created for IBD based on two generally acknowledged quality models. The model of Donabedian (Df) offers a logistical and productive perspective and the Clinical Value Compass (CVC) model adds a management and service perspective. The framework creates a pedagogical tool to understand the balance between the dimensions of clinical care (CVC) and the components of clinical outcome (Df). The merged models create a framework of the care process dimensions as a whole, reflecting important parts of the IBD care delivery system in a local setting. Clinical and organizational quality measures were adopted from clinical experience and the literature and were integrated into the framework. Data were collected at the yearly check-up for 481 IBD patients during 2008. The application of the quality assessment framework was tested and evaluated in a local clinical IBD care setting in Jonkoping County, Sweden. less thanbrgreater than less thanbrgreater thanRESULTS: The main outcome was the presentation of how locally-selected clinical quality measures, integrated into two complementary models to develop a framework, could be instrumental in assessing the quality of care delivered to patients with IBD. The selected quality measures of the framework noted less anemia in the population than previously reported, provided information about hospitalization rates and the few surgical procedures reported, and noted good access to the clinic. less thanbrgreater than less thanbrgreater thanCONCLUSION: The applied local quality framework was feasible and useful for assessing the quality of care delivered to IBD patients in a local setting.

Place, publisher, year, edition, pages
Baishideng Publishing Group Co. Limited , 2012. Vol. 18, no 10, 1085-1092 p.
Keyword [en]
Quality measures, Inflammatory bowel disease, Value compass, Donabedian, Quality improvement
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-76615DOI: 10.3748/wjg.v18.i10.1085ISI: 000301627900011OAI: diva2:515450

Funding Agencies|Futurum Research Council||Jonkoping County Council||Foundation for Clinical Cancer Research in Jonkoping County||VINNVARD-research program||

Available from: 2012-04-13 Created: 2012-04-13 Last updated: 2014-03-05
In thesis
1. Quality improvement in the care of patients with inflammatory bowel disease
Open this publication in new window or tab >>Quality improvement in the care of patients with inflammatory bowel disease
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A range of studies have supported the existence of a gap between what medicine could possibly deliver and what it actually does deliver. This is also true for the delivery of care to patients with inflammatory bowel disease (IBD) and several international stakeholders have called for action. The aim of this thesis was to describe, study and evaluate a quality improvement intervention (QII) in the care for patients with IBD in a population-based setting, with special reference to clinical redesign, performance measurement and patient experience.

The patient population on which this thesis is based was recruited from the gastroenterological unit at the Department of Internal Medicine, Highland Hospital, in Eksjö, Sweden. The QII was implemented through iterative improvement cycles in the early years of the 21st century. Data from yearly check-ups of patients including identification, gender, disease duration, medication, four questions about quality of life (QoL) and laboratory results were entered into a local register created as part of the QII. In addition, data on admittances to hospital were retrieved. The interactions between staff and patients as well as the elements of the delivered care were analysed by applying the model of clinical microsystems (CMS) and the Chronic Care Model (CCM). The QII was studied using a retrospective, descriptive analysis with quantitative elements. A multidimensional quality tool, the Clinical Value Compass (CVC), was applied to assess the quality of care. Later, the CVC and the quality model by Donabedian (Df) were merged to create a quality framework for IBD, which was tested on already existing data in the local IBD register. In a study of patients’ experiences of living with IBD, a content analysis was applied to interviews with 20 purposefully sampled patients.

The main components of the redesign, described as a “patient- and demand-directed care”, were: - A specialist nurse staffed the outpatient clinic full time and could offer patients who contacted the clinic an acute visit at the outpatient clinic within two days. - Yearly checkups to either the nurse or physician were offered, either as telephone calls or as traditional visits to the clinic. A letter preceded the contact and included a QoL questionnaire and instructions for laboratory testing of haemoglobin (Hb). The QII led to decreasing numbers of hospitalizations compared to national data and better access to care. The prevalence of anaemia in the population was 6% and was correlated to a risk of being admitted to hospital during the year. The analysis of the interviews showed several parallels to the experiences of people who  live with other chronic diseases than IBD. Consequences of living with IBD were associated with everyday life and the adaptations needed to restore one’s life. It was always shadowed by the person’s worry that he or she might potentially need a toilet.

The main contribution of this thesis is the overall example of how a quality improvement intervention including continuous performance measures and frameworks, as well as the study of patients’ experiences, can be applied in a local population-based setting. The understanding of the interactions between patients, staff and the healthcare system was described and analysed through the application of CMS and the CCM. As a whole, this thesis contributes to the international quest for quality improvement efforts to bridge the quality gap in the delivery of IBD care today.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 30 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1324
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-84633 (URN)978-91-7519-804-0 (ISBN)
Public defence
2012-11-02, Qulturum, Länssjukhuset Rybohov, Jönköping, 13:00 (English)
Available from: 2012-10-16 Created: 2012-10-16 Last updated: 2012-10-18Bibliographically approved

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Elg, MattiasSpångéus, Anna
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Quality Technology and ManagementThe Institute of TechnologyInternal MedicineFaculty of Health SciencesDepartment of Endocrinology
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