A Quality Improvement Approach to External Infliximab Infusions in Pediatric Inflammatory Bowel Disease

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 69; no. 5; pp. 544 - 550
• Main Authors: Gupta, Shivani R., Crandall, Wallace V., Donegan, Amy, Johnson, Marci, Drobnic, Barbara, Oates, Melanie, Boyle, Brendan, Maltz, Ross M., Dotson, Jennifer L.
• Format: Journal Article
• Language: English
• Published: United States by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology 01-11-2019
• Subjects: children; Crohn disease; home infusions; infliximab; infusion services; ulcerative colitis
• ISSN: 0277-2116; 1536-4801
• DOI: 10.1097/MPG.0000000000002422

ABSTRACT
Objectives:
We used a quality improvement (QI) approach to improve access and reduce barriers to care by increasing the number of external infliximab infusions at our pediatric inflammatory bowel disease center.
Methods:
Using an iterative QI strategy, pediatric patients ≥12 years of age with inflammatory bowel disease were offered the opportunity to receive infliximab infusions at home/an external infusion center. They were required to first have >5 infusions at the hospital without any significant infusion reactions. Data were collected and tracked monthly using P‐charts. Comparisons between control chart centerlines were analyzed using the Fisher exact test.
Results:
Fifty‐four patients received external infusions, 87% had Crohn disease, 63% boys, average age 17.6 ± 2.9 years, and 89% with private insurance. From September 2016 to January 2018, the percentage of eligible patients receiving external infusions was approximately 7%, increasing to approximately 30% by January 2018. A centerline shift, representing a statistically significant change, occurred in October 2016 and June 2017 (P < 0.001). No serious safety concerns have occurred.
Conclusions:
Through a multidisciplinary team of stakeholders using QI strategies, we now offer external infusion service options to all appropriate patients as routine practice. Home infusions are a viable option to reduce barriers to care, and our patients did not experience any safety events.