Comparative Effectiveness of Anti-TNF in Combination with Low Dose Methotrexate vs Anti-TNF Monotherapy in Pediatric Crohn's Disease: a Pragmatic Randomized Trial.

Childhood obesity is a common disease both nationally and in the state of Missouri. Obesity in childhood is often under-recognized and is difficult to treat. Screening, accurate diagnosis, and counseling is imperative to proper management. Common barriers to treatment include a lack of accurate identification and a lack of awareness of needed and available treatments of this disease in the pediatric setting. This review article highlights behavioral measures as well as pharmacologic and surgical therapies for obesity in children. This review is intended as guidance for providers to properly counsel and treat patients with this disease.

/pdf/childhood-obesity-in-the-state-of-missouri-a-review-for-38a9nshbap.pdf

Childhood Obesity in the State of Missouri: A Review for Providers to Counsel and Treat Patients.

Background Management of inflammatory bowel diseases (IBD) is complex and variation in care has been well-documented. However, the drivers of practice variation remain unexplored. We examined variation based on the treating gastroenterologist's IBD focus (proportion of outpatient visits for IBD). Methods We conducted a retrospective cohort of newly diagnosed patients with IBD using data from Optum's de-identified Clinformatics® Data Mart Database (2000-2020). The exposure variable was whether the treating gastroenterologist had an IBD-focus (>90th percentile of IBD visits/total outpatient visits). We used adjusted regression models to evaluate associations between provider IBD focus and process measures (use of meslamine, corticosteroid, biologic and narcotic medications and endoscopic or radiographic imaging) and clinical outcomes (time to IBD-related hospitalization and bowel resection surgery). We tested for change in treatment patterns over time by including an interaction term for study era (2004-2012 versus 2013-2020). Results The study included 772 children treated by 493 providers and 2864 adults treated by 2076 providers. In children, none of the associations between provider focus and process or outcome measures were significant. In adults, care from an IBD-focused provider was associated with more use of biologics, combination therapy, and imaging and endoscopy, and less mesalamine use for Crohn's disease (P<.05 for all comparisons) but not with other process measures. Biologics were prescribed more frequently and narcotics less frequently during the later era (P<.05 for both). Hospitalization and surgery rates were not associated with IBD-focus or era. Conclusions IBD care for adults varies by provider specialization. Given the evolving complexity, novel methods may be needed to standardize care. 

Provider Specialization in Inflammatory Bowel Diseases: Quality of Care and Outcomes

BACKGROUND
The healthcare sector is a complex domain that faces challenges in effectively learning from practices and outcome data. The Learning Health System (LHS) has emerged as a potential framework to improve healthcare by promoting continuous learning. However, its adoption remains limited, often involving only a single clinical department or a part of the LHS cycle. There is a need to gain a better understanding of implementing LHS on a larger scale.


AIM
To identify complete implementations of the LHS for providing recommendations into their implementation strategies, success factors, barriers, and outcomes.


METHODS
A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed and Scopus databases. Data from the included papers were thematically categorized into four primary areas: (1) Scale of LHS Implementation; (2) Implementation strategies and the factors that facilitated the implementation of LHS; (3) LHS outcomes; and (4) Barriers /challenges related to the LHS implementation.


RESULTS
We identified 1,279 papers, of which 37 were included in the final analysis. Barriers to implementing LHS included interoperability, data integration, electronic health records (EHRs) challenges, organizational culture, leadership, and regulatory hurdles. Most LHS initiatives lacked discussion on long-term economic sustainability models, and only 16 papers provided objective measurements of performance changes. Drawing from the findings of the included studies, this paper offers recommendations for the effective implementation of the LHS.


CONCLUSION
The establishment of sustainable LHS necessitates several key components. First, there is a need to develop long-term economic sustainability models. Secondly, governance at the national level should promote common Application Programming Interfaces (APIs) across LHS implementations, communication channels to share tacit knowledge, efficient Institutional Review Board, ethical approval processes, and connect various initiatives currently operating independently. Lastly, the success of LHS relies not only on technological infrastructure but also on the active participation of multidisciplinary teams in decision-making and sharing of tacit knowledge.

A systematic review and proposed framework for sustainable learning healthcare systems

Objective: To implement a quality improvement based system to measure and improve data quality in an observational clinical registry to support a Learning Healthcare System. Data Source: ImproveCareNow Network registry, which as of September 2019 contained data from 314,250 visits of 43,305 pediatric Inflammatory Bowel Disease (IBD) patients at 109 participating care centers. Study Design: The impact of data quality improvement support to care centers was evaluated using statistical process control methodology. Data quality measures were defined, performance feedback of those measures using statistical process control charts was implemented, and reports that identified data items not following data quality checks were developed to enable centers to monitor and improve the quality of their data. Principal Findings: There was a pattern of improvement across measures of data quality. The proportion of visits with complete critical data increased from 72 percent to 82 percent. The percent of registered patients improved from 59 percent to 83 percent. Of three additional measures of data consistency and timeliness, one improved performance from 42 percent to 63 percent. Performance declined on one measure due to changes in network documentation practices and maturation. There was variation among care centers in data quality. Conclusions: A quality improvement based approach to data quality monitoring and improvement is feasible and effective.

/pdf/implementing-a-novel-quality-improvement-based-approach-to-5atl6kizyw.pdf

Implementing a Novel Quality Improvement-Based Approach to Data Quality Monitoring and Enhancement in a Multipurpose Clinical Registry.

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Implementing a Novel Quality Improvement-Based Approach to Data Quality Monitoring and Enhancement in a Multipurpose Clinical Registry.