Abstract
Background and aim: Inflammatory bowel disease (IBD) is a global health issue with Australia (AUS) and New Zealand (NZ) having amongst the highest prevalence rates worldwide. Our study examined the quality, safety, and consistency of care amongst ten Australasian centres.
Methods: Crohn’s Colitis Care (CCCare) is a cloud-based IBD-specific electronic medical record (EMR) used in Australasia. Deidentified data prospectively entered by clinicians and consumers during routine clinical practice were retrospectively analysed. Key performance indicators (KPI) were compared across two time periods, baseline (1st October 2021 to 30th September 2022) and follow up periods (1st October 2023 to 30th September 2024). Centres with over 100 people with IBD with an assessment during the last 14-month period were included.
Result: At the end of the follow up period, 6794 people with IBD were included, 55.8% (=3790) with Crohn’s Disease, 41.3% (=2808) with Ulcerative Colitis and 2.9% (n=196) with IBD-Unclassified. There was an even gender distribution with 49.0% (n=3329) male, 48.2% (=3276) female and 2.8% (=189) did not have gender documented. The median age was 42 years (IQR 32 - 57) with a median disease duration of 11.3 years (IQR 5.6 - 19.7). The majority of people resided in AUS (71.2%, n=4834) and 28.8% (=1960) in NZ. Across the two study periods, the proportion of people receiving an advanced therapy remained stable (53.2% vs 52.9%, p=0.76), however the number of people on dose escalated (DE) therapy increased (25.1% vs 28.5%, p < 0.001). In parallel, steroid use decreased; 12.4% vs 10.5%, p < 0.01. There was a reduction in the rate of hospital admissions (4.1% vs 2.6%, p < 0.001) and surgeries (3.6% vs 1.6%, p < 0.001). There were no differences in the rates of endoscopic (53.1% vs 54.7%, p=0.34) and radiologic remission (41.0% vs 43.0%, =0.49). There was a significant reduction in the completion of healthcare maintenance across all sites with a fall in overall covid vaccination (36.9% vs 29.8%, p<0.001), influenza vaccination (20.1% vs 5.0%, p<0.001) and skin care checks (12.0% vs 4.0%, p<0.001). There was no significant difference in the proportion of people currently smoking (10.5% vs 10.9%, p=0.54).
Conclusion: Observed clinical improvements, including reduced steroid use, admissions, and surgeries, coincided with increased DE therapy, reflecting a shift toward tailored healthcare. Post-pandemic reduction in healthcare maintenance likely reflects provider and consumer fatigue. Implementing a value-based IBD management approach with continuous KPI monitoring via digital tools like CCCare is essential for optimizing outcomes, highlighting trends, and identifying areas for improvement in healthcare delivery.