Evaluation, Research and Development Unit

Integrated care pathway for Inflammatory Bowel Disease

Background

The National Audit of IBD Services and Care (2006) and findings from our own research, have demonstrated unacceptable variations in service provision and organisation of clinical care. National Standards of Care for IBD, intended for NHS Managers and Healthcare Commissioning Organisations have been published in order to improve services for patients. Through a collaboration between the local Primary Care Trust and Acute Trust, Durham University and the National Association for Colitis and Crohn's Disease, an integrated care pathway (ICP) for patients with inflammatory bowel disease, a UK first, is being established in Stockton-on-Tees.  ERDU will determine the impact on clinical care and health resource utilisation resulting from introduction of an integrated care pathway for IBD, and to elicit the organisational and system factors that impact on its introduction.

Methods

The evaluation will use a mixed methods approach, addressing the impact on health outcomes and resource use, the patient experience and inequalities of care.  We will utilise a naturalistic before and after approach, retrieving and analysing clinical data collected for the purpose of the pilot as well as routinely collected patient-level data in primary and secondary care. There is likely to be an opportunity to obtain control data from adjoining Trusts, to identify contemporaneous trends. 

To assess improvement in care we will measure changes in numbers of unplanned admissions. We will also measure changes in case mix for planned admissions and in outpatient activity, measured in absolute terms and by new: review ratio. To assess whether care is better co-ordinated, we will measure the uptake of structured primary care reviews, their completeness and the actions that result. We will undertake sub-analyses, for example by deprivation status, to understand inequalities in health care. The patient experience will be studied using the Patient Enablement Instrument Patient Reported Outcome Measure (UK-SIBDQ) as well as qualitative methods such as 1:1 interviews and focus groups.

Timescale

The pilot will run for 2 years from 2010. The evaluation is the subject of a PhD study (2009-12)

Funding

Pharmacy Practiuce Research Trust Linstead Fellowship for Mr Will Horsley to undertake PhD study: £30,000

National Association for Crohn's and Colitis: £30,000

Contact g.p.rubin@durham.ac.uk or william.horsley@durham.ac.uk