Project

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Appropriateness of care in inflammatory bowel disease

Applicant Pittet Valérie
Number 138498
Funding scheme Project funding (special)
Research institution
Institution of higher education University of Lausanne - LA
Main discipline Methods of Epidemiology and Preventive Medicine
Start/End 01.03.2012 - 31.07.2015
Approved amount 296'000.00
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Keywords (12)

Quality of care; Appropriateness of care; Evidence-based medicine; Health services research; Inflammatory bowel diseases; Outcomes; Adherence to guidelines; Patient preferences; Crohn's disease; Ulcerative colitis; Swiss Inflamatory Bowel Disease Cohort Study; large nested project (SIBCS)

Lay Summary (English)

Lead
Lay summary

Appropriateness of care in Inflammatory Bowel Diseases

Appropriateness of care is an essential element of high quality care, but the translation of the science of appropriateness into actual care is lagging behind. Among the fields where initial work has been done in evaluating appropriateness of care is inflammatory bowel disease (IBD), yet very little is known about the actual appropriateness of care for IBD patients. We will take advantage of the experience, expertise and data of a large national cohort of IBD (Swiss IBD Cohort Study – SIBDCS) to study the level of appropriate and inappropriate care and to evaluate mechanisms which influence appropriateness. This will be the main focus of the present project. Appropriateness of care is traditionally determined from the purely medical perspective. Yet, equally important is the patient point of view and it is essential that those developing criteria for appropriateness of care, evaluating risk and benefit to the patient, can ensure that the risks and benefits they are considering are those most important to patients themselves. Finally, the fundamental question of whether the provision of appropriate care actually leads to improved outcome has hardly been addressed in previous studies.

Objectives. This project is aimed at addressing important gaps concerning the adherence, acceptability and applicability of criteria for evaluating appropriateness of care, and specifically the treatment of patients suffering from IBD. Objectives are: (A) to assess the degree of appropriate and inappropriate care in a large national cohort of IBD patients and its impact on patient outcomes; (B) to assess the perceptions of relevance and acceptability of criteria for evaluating appropriateness of care to specialists who are called upon to apply them and to patients whose care is being evaluated; to study and compare how specialists or patients do prioritize outcomes associated with appropriateness of care.

Methods.  A. To document the level of appropriate and inappropriate care for IBD patients we will apply the criteria for appropriateness of care we recently developed to the patients enrolled in the Swiss IBD Cohort Study (SIBDCS). We will categorize patient treatments according to appropriateness and analyze the determinants of appropriate care related to patients, treatments, physicians and the care environment, and assess patients’ outcomes. Outcomes to be evaluated are quality of life, satisfaction with and adherence to treatment, disease exacerbations (flares), hospitalization, surgery and treatment changes. B. Acceptance of and adherence to criteria for the appropriateness of care, as well as outcomes prioritizations, will be assessed by submitting to a sample of practicing gastroenterologists, clinical scenarios of relevant and common indications for treatment of IBD and their related degree of appropriateness. To complement this theoretical level, a sample of gastroenterologists will be asked to consult over a 4-week period, and for each new decision related to IBD, the criteria developed by two expert panels for the treatment of IBD and indicate their agreement with the criteria and/or reasons for disagreement. Patients’ perspectives on, and weightings of potential benefits deriving from, or risks related to treatments for IBD will be assessed and compared to similar perspectives from clinicians.

Expected results and importance. This study will help answer practical and important questions and address previously unstudied aspects of how to provide high quality care.

Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Patient-reported healthcare expectations in inflammatory bowel diseases
Pittet Valérie, Vaucher Carla, Froehlich Florian, Maillard Michel H., Michetti Pierre (2018), Patient-reported healthcare expectations in inflammatory bowel diseases, in PLOS ONE, 13(5), e0197351-e0197351.
Patient self-reported concerns in inflammatory bowel diseases: A gender-specific subjective quality-of-life indicator
Pittet Valérie, Vaucher Carla, Froehlich Florian, Burnand Bernard, Michetti Pierre, Maillard Michel H. (2017), Patient self-reported concerns in inflammatory bowel diseases: A gender-specific subjective quality-of-life indicator, in PLOS ONE, 12(2), e0171864-e0171864.
Patients and gastroenterologists’ perceptions of treatments for inflammatory bowel diseases: do their perspectives match?
Vaucher Carla, Maillard Michel H., Froehlich Florian, Burnand Bernard, Michetti Pierre, Pittet Valérie (2016), Patients and gastroenterologists’ perceptions of treatments for inflammatory bowel diseases: do their perspectives match?, in Scandinavian Journal of Gastroenterology, 51(9), 1056-1061.
Acceptance of inflammatory bowel disease treatment recommendations based on appropriateness ratings: do practicing gastroenterologists agree with experts?
Pittet Valérie, Maillard Michel H, Lauvergeon Stéphanie, Timmer Marjan, Michetti Pierre, Froehlich Florian, Burnand Bernard, Vader John-Paul, Mottet Christian, Pittet Valérie, Maillard Michel H, Lauvergeon Stéphanie, Timmer Marjan, Michetti Pierre, Froehlich Florian, Burnand Bernard, Vader John-Paul, Mottet Christian (2015), Acceptance of inflammatory bowel disease treatment recommendations based on appropriateness ratings: do practicing gastroenterologists agree with experts?, in Journal of Crohn's & colitis, 9(2), 132-9.
Characteristics of non-responders to self-reported questionnaires in a large inflammatory bowel disease cohort study.
Multone Eléonore, Vader John-Paul, Mottet Christian, Schoepfer Alain, Fournier Nicolas, Burnand Bernard, Michetti Pierre, Pittet Valérie, Multone Eléonore, Vader John-Paul, Mottet Christian, Schoepfer Alain, Fournier Nicolas, Burnand Bernard, Michetti Pierre, Pittet Valérie (2015), Characteristics of non-responders to self-reported questionnaires in a large inflammatory bowel disease cohort study., in Scandinavian journal of gastroenterology, 50(11), 1348-56.
Appropriateness and long-term discontinuation rate of biological therapies in ulcerative colitis.
Maillard Michel H, Bortolotti Murielle, Vader John-Paul, Mottet Christian, Schoepfer Alain, Gonvers Jean-Jacques, Burnand Bernard, Froehlich Florian, Michetti Pierre, Pittet Valérie, Swiss IBD Cohort Study Group, Maillard Michel H, Bortolotti Murielle, Vader John-Paul, Mottet Christian, Schoepfer Alain, Gonvers Jean-Jacques, Burnand Bernard, Froehlich Florian, Michetti Pierre, Pittet Valérie, Swiss IBD Cohort Study Group (2014), Appropriateness and long-term discontinuation rate of biological therapies in ulcerative colitis., in Journal of Crohn's & colitis, 8(8), 825-34.
Patients' information-seeking activity is associated with treatment compliance in inflammatory bowel disease patients.
Pittet Valérie, Rogler Gerhard, Mottet Christian, Froehlich Florian, Michetti Pierre, de Saussure Philippe, Burnand Bernard, Vader John-Paul, Swiss IBD Cohort Study Group, Pittet Valérie, Rogler Gerhard, Mottet Christian, Froehlich Florian, Michetti Pierre, de Saussure Philippe, Burnand Bernard, Vader John-Paul, Swiss IBD Cohort Study Group (2014), Patients' information-seeking activity is associated with treatment compliance in inflammatory bowel disease patients., in Scandinavian journal of gastroenterology, 49(6), 662-73.
The gap between scientific evidence and clinical practice: 5-aminosalicylates are frequently used for the treatment of Crohn's disease.
Schoepfer A M, Bortolotti M, Pittet V, Mottet C, Gonvers J-J, Reich O, Fournier N, Vader J-P, Burnand B, Michetti P, Froehlich F, Schoepfer A M, Bortolotti M, Pittet V, Mottet C, Gonvers J-J, Reich O, Fournier N, Vader J-P, Burnand B, Michetti P, Froehlich F (2014), The gap between scientific evidence and clinical practice: 5-aminosalicylates are frequently used for the treatment of Crohn's disease., in Alimentary pharmacology & therapeutics, 40(8), 930-7.
When do we dare to stop biological or immunomodulatory therapy for Crohn's disease? Results of a multidisciplinary European expert panel.
Pittet Valerie, Froehlich Florian, Maillard Michel H, Mottet Christian, Gonvers Jean-Jacques, Felley Christian, Vader John-Paul, Burnand Bernard, Michetti Pierre, Schoepfer Alain, EPACT-II Update Panellists, Pittet Valerie, Froehlich Florian, Maillard Michel H, Mottet Christian, Gonvers Jean-Jacques, Felley Christian, Vader John-Paul, Burnand Bernard, Michetti Pierre, Schoepfer Alain, EPACT-II Update Panellists (2013), When do we dare to stop biological or immunomodulatory therapy for Crohn's disease? Results of a multidisciplinary European expert panel., in Journal of Crohn's & colitis, 7(10), 820-6.

Collaboration

Group / person Country
Types of collaboration
Haute Ecole d'Ingénierie et de Gestion du Canton de Vaud (HEIG-VD) Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Industry/business/other use-inspired collaboration
Département de gastroentérologie / HUG, Genève Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
ECCO (European Crohn's Colitis Organisation) Austria (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Industry/business/other use-inspired collaboration
Klinik für Gastroenterologie u. Hepatologie / Universität Zürich Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Département de gastroentérologie / CHUV, Lausanne Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Division of Gastroenterology / University Hospital, Basel Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
ECCO (European Crohn’s and Colitis Organization) meeting Poster Characteristics of non-responders to self-reported questionnaires in a large inflammatory bowel disease cohort study 18.02.2015 Barcelona, Spain Pittet Valérie; Michetti Pierre;
ECCO (European Crohn’s and Colitis Organization) meeting Poster Patients and gastroenterologists’ perceptions of treatments in Inflammatory Bowel Disease: Do doctors and patients speak the same language? 18.02.2015 Barcelona, Spain Pittet Valérie; Michetti Pierre;
ECCO (European Crohn’s and Colitis Organization) meeting Individual talk Information needs and concerns of patients with inflammatory bowel disease: what can we learn from participants of a national clinical cohort? 18.02.2015 Barcelona, Spain Pittet Valérie; Michetti Pierre;
UEGW (United European Gastroenterology Week) meeting Poster Appropriateness and Long-term Discontinuation Rate of Biological Therapies in Ulcerative Colitis. 20.10.2014 Vienna, Austria Froehlich Florian;
Digestive Disease Week Poster Appropriateness and Long-term Discontinuation Rate of Biological Therapies in Ulcerative Colitis 21.05.2014 Chicago, United States of America Michetti Pierre; Froehlich Florian;
ECCO (European Crohn’s and Colitis Organization) meeting Poster Appropriateness and Long-term Discontinuation Rate of Biological Therapies in Ulcerative Colitis. 20.02.2014 Copenhagen, Denmark Pittet Valérie; Michetti Pierre;
Digestive Disease Week Poster When to stop therapy in Crohn’s disease? Results of the EPACT-II Update panel. 18.05.2013 Orlando, United States of America Froehlich Florian;
ECCO (European Crohn’s and Colitis Organization) meeting Individual talk When to stop therapy in Crohn’s disease? Results of the EPACT-2 Update panel. 15.02.2013 Vienna, Austria Michetti Pierre; Pittet Valérie;
International Society for Quality in Healthcare (ISQua) conference Individual talk Is There a Relationship Between Information Concerns of Patients and Adherence to Therapy? Findings from the Swiss Inflammatory Bowel Disease Cohort Study. 21.10.2012 Geneva, Switzerland Pittet Valérie;
Annual meeting of the Swiss Society of Gastroenterology Poster Is there a Relationship Between Information Concerns of Patients and Adherence to Therapy: Findings from the Swiss Inflammatory Bowel Disease Cohort Study? 20.09.2012 Interlaken, Switzerland Froehlich Florian; Pittet Valérie; Michetti Pierre;
Annual meeting of the Swiss Society of Gastroenterology Poster First Explicit Criteria to Decide on the Appropriateness of Therapy of Ulcerative Colitis: the European EPATUC Panel” 20.09.2012 Interlaken, Switzerland Michetti Pierre; Pittet Valérie; Froehlich Florian;
Swiss Public Health Conference Poster Is there a Relationship Between Information Concerns of Patients and Adherence to Therapy: Findings from the Swiss Inflammatory Bowel Disease Cohort Study” 30.08.2012 Lausanne, Switzerland Pittet Valérie; Vader John-Paul;
DDW (Digestive Disease Week) Poster Appropriateness of treatment for fistulizing Crohn’s disease: Findings from a nationwide inflammatory bowel disease cohort. 19.05.2012 San Diego, United States of America Pittet Valérie;


Associated projects

Number Title Start Funding scheme
134274 Schweizer IBD Kohorten Studie 01.04.2011 Cohort Studies Large

Abstract

Background : Appropriateness of care is an essential element of high quality care, but the translation of the science of appropriateness into actual care is lagging behind. Among the fields where initial work has been done in evaluating appropriateness of care is inflammatory bowel disease (IBD), yet very little is known about the actual appropriateness of care for IBD patients. We will take advantage of the experience, expertise and data of a large national cohort of IBD (Swiss IBD Cohort Study - SIBDCS) to study the level of appropriate and inappropriate care and to evaluate mechanisms which influence appropriateness. This will be the main focus of the present project. Appropriateness of care is traditionally determined from the purely medical perspective. Yet, equally important is the patient point of view and it is essential that those developing criteria for appropriateness of care, evaluating risk and benefit to the patient, can ensure that the risks and benefits they are considering are those most important to patients themselves. Finally, the fundamental question of whether the provision of appropriate care actually leads to improved outcome has hardly been addressed in previous studies. Objectives. This project is aimed at addressing important gaps concerning the adherence, acceptability and applicability of criteria for evaluating appropriateness of care, with specific reference to the treatment of patients suffering from inflammatory bowel disease (IBD): A. What is the degree of appropriate and inappropriate care in a large national cohort of IBD patients? B. What are the perceptions of relevance and acceptability of criteria for evaluating appropriateness of care to specialists who are called upon to apply them and to patients whose care is being evaluated? And how do specialists or patients prioritize outcomes associated with appropriateness of care? C. What is the impact of appropriate care on patient outcomes? Methods. A. To document the level of appropriate and inappropriate care for patients with IBD we will extend our previous work on CD to the other major disease entity in IBD, ulcerative colitis (UC). Criteria for appropriateness of care in IBD exist but have so far not been widely applied to the patients enrolled in the Swiss IBD Cohort Study (SIBDCS). We will categorize patient treatments according to appropriateness and analyze the determinants of appropriate care related to patients, treatments, physicians and the care environment. B. Acceptance of and adherence to criteria for the appropriateness of care, as well as prioritization of outcomes, will be assessed by submitting to a sample of practicing gastroenterologists, clinical scenarios of relevant and common indications for treatment of IBD and their related degree of appropriateness. To complement this theoretical level, a sample of gastroenterologists will be asked to consult over a 4-week period, and for each new decision related to IBD, the criteria developed by two expert panels for the treatment of IBD and indicate their agreement with the criteria and/or reasons for disagreement. Patient perspectives on, and weightings of potential benefits deriving from, or risks related to treatments for IBD will be assessed and compared to similar perspectives from clinicians. C. Using clinical data collected prospectively from patients enrolled in the Swiss IBD cohort, the relationship between of appropriateness of care and outcomes of care will be evaluated. Outcomes to be evaluated are quality of life, satisfaction with treatment, daily functioning, disease exacerbations (flares), hospitalization, surgery and treatment change.Expected results and importance. This study will help answer practical and important questions and address previously unstudied aspects of how to provide high quality care. Key words. Quality of care, appropriateness of care, clinical practice guidelines, evidence-based medicine, health services research, inflammatory bowel disease, Crohn’s disease, ulcerative colitis, outcomes, adherence to guidelines, patient preferences.
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