Received: 24 February 2021 DOI: 10.1002/ueg2.12105 ORIGINAL ARTICLE - Accepted: 15 April 2021 Inflammatory bowel disease integral care units: Evaluation of a nationwide quality certification programme. The GETECCU experience Manuel Barreiro‐de Acosta1 | Ana Gutiérrez2,3,4 | Yamile Zabana4,5 | Belén Beltrán4,6 | Xavier Calvet4,7 | María Chaparro4,8 | Eugeni Domènech4,9 | Maria Esteve4,5 | Julian Panés4,10 | Javier P. Gisbert4,8 | Pilar Nos4,6 | on behalf GETECCU 1 Hospital Clínico Universitario de Santiago De Compostela, Santiago, Spain Abstract 2 Hospital General Universitario Alicante, Background: One of the most valued targets in inflammatory bowel disease (IBD) is Alicante, Spain for physicians to provide and patients to receive a high‐level quality of care. This 3 Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, study aimed to evaluate the implementation of a nationwide quality certification Spain programme for IBD units. 4 Centro de Investigación Biomédica en Red de Methods: Identification of quality indicators (QI) for IBD Unit certification was Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain based on Delphi methodology that selected 53 QI, which were subjected to a 5 Hospital Universitari Mútua Terrassa, normalisation process. Selected QI were then used in the certification process. Terrasa, Spain Coordinated by GETECCU, this process began with a consulting round and an audit 6 Hospital Universitario y Politécnico La Fe, drill followed by a formal audit carried out by an independent certifying agency. This Valencia, Spain 7 audit involved the scrutiny of the selected QI in medical records. If 80%–90% Corporació Sanitaria Universitària Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, compliance was achieved, the IBD unit audited received the qualification of Spain “advanced”, and if it exceeded 90% the rating was “excellence”. Afterwards, an 8 Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa anonymous survey was conducted among certified units to assess satisfaction with (IIS‐IP), Universidad Autónoma de Madrid the programme for IBD units. (UAM), Madrid, Spain Results: As of January 2021, 66 IBD units adhere to the nationwide certification 9 Hospital Universitari Germans Trias i Pujol, Badalona, Spain programme. Among the 53 units already audited by January 2021, 31 achieved the 10 Hospital Clinic Barcelona, IDIBAPS, certification of excellence, 20 the advanced certification, and two did not obtain the Barcelona, Spain certification. The main survey results indicated high satisfaction with an average Correspondence score of 8.5 out of 10. Manuel Barreiro‐de Acosta, IBD Unit, Hospital Conclusion: Certification of inflammatory bowel disease units by GETECCU is the Clínico Universitario de Santiago De largest nationwide certification programme for IBD units reported. More than 90% Compostela, Choupana S/N 15701 Santiago de Compostela, A Coruña, Spain. of IBD units adhered to the programme achieved the certification. Email: manubarreiro@hotmail.com KEYWORDS inflammatory bowel disease, quality indicators, quality of care, standards, unit - This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. © 2021 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology. 766 United European Gastroenterol J. 2021;9:766–772. wileyonlinelibrary.com/journal/ueg2 BARREIRO‐DE ACOSTA ET AL. - 767 INTRODUCTION Key points Inflammatory bowel disease (IBD), either Crohn’s disease (CD) or Summarise the established knowledge on this subject ulcerative colitis (UC), is a chronic, progressive, and life‐long con- dition that affects a large number of people in our country.1,2 � One of the most highly valued targets in IBD treatment is Lifetime medical costs associated with IBD care are comparable to to achieve a high‐level quality of care those of other severe chronic diseases such as diabetes mellitus or � IBD units are the best way to provide this high‐level cancer.3 IBD is typically managed by gastroenterologists in collab- quality of care oration with other healthcare specialities. IBD is, therefore, a multifaceted and complex disease with a major impact on the pa- What are the significant and/or new findings of this study? tient’s quality of life. For this reason, it is best managed in a spe- � CUE is the largest nationwide certification programme cialised IBD unit with a multidisciplinary team of experts in the for IBD units reported to date. different aspects of this disease.4 Furthermore, the presence of an � Certification by an independent agency gives added IBD specialist nurse is compulsory in an IBD unit to provide physical value to the programme. and emotional support to patients, together with healthcare � More than 90% of IBD units that adhered to the pro- education.5 gramme achieved the certification. The Spanish Working Group on Crohn’s Disease and Ulcerative Colitis (GETECCU) is a Medical Society with more than 30 years of history and more than one thousand members all over our country. It has the mission to promote excellence in healthcare, teaching, and research, establishing reliable standards of IBD care in Spain. In accordance with these principles, a group of GETECCU gastroen- The certification process terologists developed a set of quality indicators (QI), based on Delphi methodology and in collaboration with other stakeholders such as The project was one of the strategic lines of GETECCU and discussed patients’ associations and nurses. Fifty‐three of these QI (18 of by the committee that designed that project. It was presented to all structure, 32 of process, and 3 of results) were then selected and GETECCU members in order to subscribe to it. IBD units voluntarily 6 subjected to a normalisation process. GETECCU decided that applied for certification. Once an IBD unit applied, an initial visit to compliance with these indicators should define the essence of an IBD the centre was performed to ascertain the level of compliance with unit. all the indicators and establish an action plan. Once a unit considered Quality of care audits have been performed for other diseases, it was ready for the audit, a mock audit supported by GETECCU was including audits of stroke units supported by the European Stroke carried out within approximately 5 months from the first visit. An Organisation.7 Within IBD care, there have been other rather limited independent auditor performed the mock audit. After the mock audit, programmes similar to ours that retrospectively audited medical re- a confidential report was sent by the same independent auditor to cords from practices in academic, community, and private centres in the IBD unit to find out if they are now ready for the official audit. the United States to assess adherence to quality measures published Two months later, an official audit was carried out by an external by the American Gastroenterological Association (AGA).8 However, independent agency called Bureau Veritas, a global leader company these were not comparable to a nationwide audit in a country with in inspection, audits, and certification for over 30 years (https://www. nearly 50 million inhabitants and with most IBD units predominantly bureauveritas.es). The final audit consisted of a 2‐day visit to the unit located in the public health system. with an exhaustive review of all selected indicators. This audit Therefore, this study aimed to describe the implementation of a included the evaluation of the structure of the institution (gastro- nationwide programme for IBD unit certification, the so‐called cer- enterology, surgery, endoscopy, and radiology departments), the re- tification of inflammatory bowel disease units (CUE) programme of view of all protocols, and the assessment of their compliance through GETECCU. A secondary objective was to report the perception of the review of medical records. It also included an interview with all IBD professionals on the usefulness of the evaluation programme. the members of the multidisciplinary team, including nurses and surgeons, a review of their curriculum vitae, and, finally, a detailed random evaluation of 40 medical records of different clinical sce- METHODS narios (patients in remission, mild or severely active disease, post‐ surgical setting, hospitalised, pregnant, under cancer surveillance This is a descriptive study evaluating the implementation of a programme, etc.). If a centre has a referral surgery hospital and has nationwide programme for IBD units certification based on compli- an official agreement with that hospital and it is verified in the ance with the 53 selected QI (18 related to structure, 32 to process, medical records that all surgical patients are systematically sent to and 3 to results) (legal deposit: BI‐1125‐2016) previously published referral, the standard is considered to be correct. The condition must by GETECCU (Table S1).6 be that the referral centre has previously demonstrated certification. 768 - UNITED EUROPEAN GASTROENTEROLOGY JOURNAL After the audit, the independent auditor emitted a verdict with RESULTS a detailed report, including the degree of compliance with the QI. If compliance exceeded 90%, the unit was given the rating The CUE programme started in 2017. As of January 2021, 66 Spanish “excellence”, and the unit has to be re‐certified in 3 years. If 80%– IBD units adhere to the certification programme nationwide, of which 90% compliance was achieved, the Unit was qualified as 53 have already been audited. As shown in Figure 2, 30 (56%) IBD “advanced”, and must be re‐certified in 2 years. In those cases with units evaluated in our country achieved a certification grade of less than 80% compliance, the unit was not awarded the certifi- excellence, and 21 (40%) a certification grade of advanced. The cation, but GETECCU compromised to help the IBD unit with an geographical location of certified IBD units is shown in Figure 3. The action plan to improve the missing indicators. The unit was certified IBD units are distributed among 13 of the 17 regions in our allowed to apply again for the certification after a minimum six‐ country. The most populated areas in Spain, such as Catalonia and month period. Madrid (where the two biggest cities Barcelona and Madrid are Finally, an official act of certification delivery was held in which located), were the regions with a higher number of certified units, regional health system managers, hospital directives, and patients’ although the distribution was relatively homogeneous throughout associations (called ACCU in Spain, https://accuesp.com) were the country. There are four regions (Extremadura, La Rioja, Murcia, invited. There was coverage of the delivery act by both local and and Canary Islands) without certified units, although the first two are national media. Figure 1 shows the flowchart of the process. less populated regions of Spain. The 51 certified IBD units cover a population of 18.157.258 inhabitants, which represents 38.3% of the Spanish population according to data obtained from the national Assessment of certification statistics institute (https://www.ine.es). To date, 13 units are in the certification programme’s first steps The number and percentage of IBD units that achieved certification (eight have completed the first visit, and five have completed the (grouped as advanced and excellent) among all those that applied, was evaluated. The percentage of the Spanish population covered by the certified IBD units was analysed; this process consisted of calculating the health population area of all certified IBD units and dividing by the Spanish population. The compliance rate with each QI was also analysed in all the units that have achieved the certification. To evaluate the professional’s perception of the certification programme, gastroenterologists participating in the programme ful- filled a questionnaire after the certification process. The question- naire included eight items regarding the contribution of the certification process to the care provided to IBD patients, with an- swers given on a Likert scale from 1 to 10 points (10 being the highest score). Two questions assessing future areas for improve- ment of the programme were open‐ended. The impact of the CUE programme in local and national media was also evaluated. F I G U R E 2 Percentage of inflammatory bowel disease units Results of certified IBD units are shown in percentages. Results audited that achieved excellence, advanced degree, or did not pass of the questionnaire are shown in mean and standard deviation. the certification process FIGURE 1 Flowchart of the certification process BARREIRO‐DE ACOSTA ET AL. - 769 practice audit). Most of these units applied to the CUE programme Since the start of the CUE programme, every time an IBD unit during the COVID‐19 pandemic, and it is expected that they will be achieved the certification, an official act of certification delivery was audited within the following months. held, and a press release was written and sent to the local and na- Detailed evaluation of the 53 selected QI showed that 40 QI tional media. Their main messages were about the importance of were achieved in more than 90% of the units. There were two QI that early diagnostic and treatment of IBD, the role of multidisciplinary were reached by less than 50% of the units; one was related to the teams, the need for monitorisation, and the relevance of quality of written report of the information given to the patients about care in IBD. At the end of 2020, the total number of impacts in the the potential risks of biological and immunosuppressant drugs in the media amounted to 437. Of them, 36% were published in specialised clinical records, and the other was related to the performance of at health media and 64% in general media (42% national and 58% local). least 10 ileoanal pouch surgeries within the previous year. The per- centage of QI achieved per each question is shown in Table S1. The first 40 IBD units audited answered a questionnaire to DISCUSSION evaluate the perceptions on and the satisfaction with the CUE pro- gramme. The results are shown in Table 1. The results showed a high To the best of our knowledge, this is the largest nationwide study to satisfaction rate with the CUE programme, with an average score of date which provides evidence on the possibility of implementation of 8.5, out of 10; scores were over eight in all questions. Regarding the a certification programme for IBD units. With our results, based on open questions concerning future issues for the improvement of the more than 50 IBD units certified all over the country, almost 40% of programme, the more demanded ones were to give more weight to the Spanish population can be attended with certified quality care in paediatric transition and nutritional support for patients. IBD. Further development of the programme has the potential to enable many Spanish IBD patients to be cared for in a certified IBD unit. This is likely to improve the overall quality of care for IBD patients. One of the most valued targets in IBD treatment is for physicians to provide and patients to receive a high‐level quality of care.9 Nevertheless, this is not easy to achieve, especially in a nationwide public health system. There are reliable data showing huge differ- ences in clinical care in IBD. A survey of patients with CD and UC in the United States demonstrated wide variation in practice between gastroenterologists in academic centres more specialised in IBD versus private practice and general gastroenterologists. Patients treated in academic centres received fewer steroids and more bio- logical therapy when compared to private and general practices. Patients treated by gastroenterologists from academic centres were also more likely to be in remission, receive the flu vaccine, and have better quality of life.10 In a retrospective propensity‐matched scored F I G U R E 3 Geographically distribution of certified study performed in a Canadian centre, the authors compared the inflammatory bowel disease units in Spain quality of care in IBD before and after implementing an integrated TABLE 1 Results from the satisfaction questionnaire among audited IBD units Questions Mean (SD) Has the certification process of my IBD unit contributed or will contribute to standardize 8.37 (1.37) the care of my patients? Has this process contributed or will contribute to improving the quality of care offered to 8.48 (1.65) my patients? Has this process helped to give value to the role of the nurse in my centre? 8.57 (2.64) Has the certification process met my expectations? 8.33 (1.16) Have the previous training and the two preparation visits been valuable and flexible? 8.17 (1.85) Has the audit been useful to identify areas for improvement? 9.03 (0.95) Has the award ceremony contributed to highlighting the IBD unit within the hospital? 8.93 (1.21) Would you recommend joining the program to a colleague from another hospital? 9.20 (0.75) Abbreviation: IBD, Inflammatory bowel disease. 770 - UNITED EUROPEAN GASTROENTEROLOGY JOURNAL model of care with a trained gastroenterologist specialist, specialised London (www.rcplondon.ac.uk/ibd) has supported the development IBD nurses, registered dieticians, and a clinical psychologist. Patients of national standards for IBD care and helped establish quality IBD treated within this model of care presented lower rates of IBD‐ care as a key component of local healthcare delivery.21,22 To our related hospitalisation, lower levels of corticosteroid dependence, knowledge, in difference with the Spanish program, the UK did not and higher rates of immunomodulatory and biological use.11 The grant specific certifications to IBD units. Another difference is that European Crohn’s and Colitis Organisation (ECCO) conducted a web‐ our program is evaluated by a personalised audit performed onsite by based survey study of 4670 patients from 25 different European an external association/company. This contrasts with the UK Audit, countries of which only 52% reported adequate access to care.12 where each participating site submits their local data, and they are Several other studies have identified variation in levels of care, and, compared against a national benchmark (https://ibdregistry.org.uk/ against this background, a certification of IBD units could be a path data‐submission‐framework/). Another nationwide programme for improving standards of care in IBD.13,14 known for evaluating IBD quality of care was implemented in The best way to measure quality of care in IBD is by using QI. In Romania, with an audit of QI. However, the publication only included response to the variation in care between practitioners, QI have been the programme’s protocol but not the results obtained after the 15 16 developed in both the United States and Canada for IBD man- audits nor the number of IBD units certified.23 agement, with 11 QI in each case. We used the GETECCU QI for the Compared with other diseases with higher economic costs, IBD certification programme, which consists of 53 QI based on Delphi has limited media visibility and social media for society.24 For this methodology and which were further validated in our country by reason, some other groups like the Crohn’s & Colitis Foundation of patients and nurses.6 Recently ECCO published their own 90 quality America try to give value and importance to IBD in economic of care standards in IBD, with a high concordance with GETECCU’s terms.25 We hope that giving a higher impact of the disease in the 17 QI, which supports the current validity of our QI. However, due to media and showing the importance of IBD units for society will help the rapid changes in IBD management, GETECCU is currently attract future IBD stakeholders. working on and updating the QI. There are, however, various limitations in our programme. First, Some programmes in the United States audited IBD clinical adherence to the programme is voluntary. Furthermore, the results practices to determine the quality of care, but their results mainly obtained in the satisfaction questionnaire could be biased, because addressed private practice and reimbursement.10 Prospective data is they were answered just after certification, this being a moment of aggregated in a central database and used to generate weekly audit great optimism in the unit. Finally, our results could be difficult to and feedback reports for the participating centres. These reports are extrapolate to other countries with different or more private health- reviewed by the sites, and modifications are made to processes to care systems due to Spain’s predominantly public health care system. improve outcomes. Involvement in this programme resulted in an On the other hand, our study has several strengths. The main one increase in remission rates from 55% to 75% over the past few is the external evaluation by an independent agency specialised in years.15,18 certification. The quality of the certification programme is based on A well‐designed nationwide study evaluating the quality of care QI that have been designed with Delphi methodology and previously in IBD has been performed in New Zealand. The programme con- published by our Medical Society.6 Another strength is the homo- sisted of three phases, the third being an audit of key aspects of IBD geneity of the programme all over our country, which is an oppor- care. However, the audit, which was performed in 14 centres in tunity for a patient with IBD located anywhere in the national contrast to ours, was more focused on validating the role of nursing territory to be treated with the same quality standards. than evaluating the global aspects of an IBD unit.19 Another In conclusion, CUE is the largest nationwide certification pro- nationwide study was performed in Australia. It consisted of a two‐ gramme for IBD units reported to date. More than 90% of IBD units phase programme, a cross‐sectional survey completed by the physi- that adhered to the programme achieved the certification. The sup- cians, and a clinical audit assessing organisational resources, clinical port of patient associations and managers is essential for giving value processes, and outcome measures. The main difference with the to this type of project. This programme has increased IBD and Spanish programme was that in Australia only hospitalised IBD pa- GETECCU visibility in our country. This is probably the first step tients were audited, while in the GETECCU programme all groups of towards homogenising IBD assistance all over the country. patients (including outpatients) were evaluated in the audit. Results were rather unexpected because the authors concluded that only one F UN D I NG hospital met the standards for multidisciplinary IBD care.20 AbbVie sponsored the CUE programme. AbbVie had no role in the In Europe, the National UK IBD audit programme was estab- study design, data collection and analysis, decision to publish, or lished with the aim of improving the quality and safety of care for preparation of the manuscript. people with IBD throughout the UK. The first round of UK‐wide audit took place in 2006 with another four rounds in the following years A C K NO W L ED G E M E NT S and has shown substantial improvements in care over time. This Javier Santiago, Jesús Martín, Bureau Veritas, patient’s associations complete programme endorsed by the Royal College of Physicians of (ACCU), and all IBD units adhered to the programme. BARREIRO‐DE ACOSTA ET AL. - 771 C O N F LI C T S O F I N T E R ES T Critical revision of the manuscript for important intellectual content: Manuel Barreiro‐de Acosta has served as a speaker, consultant, and Manuel Barreiro‐de Acosta, Ana Gutiérrez, Yamile Zabana, Belén advisory member for or has received research funding from MSD, Beltrán, Xavier Calvet, María Chaparro, Eugeni Domènech, Maria AbbVie, Janssen, Kern Pharma, Celltrion, Takeda, Gillead, Celgene, Esteve, Julian Panés, Javier P. Gisbert, and Pilar Nos. Approval of the Pfizer, Ferring, Faes Farma, Shire Pharmaceuticals, Dr. Falk Pharma, final manuscript: Manuel Barreiro‐de Acosta, Ana Gutiérrez, Yamile Chiesi, Gebro Pharma, Adacyte, and Vifor Pharma. Ana Gutiérrez has Zabana, Belén Beltrán, Xavier Calvet, María Chaparro, Eugeni served as a speaker, a consultant, and advisory member for or has Domènech, Maria Esteve, Julian Panés, Javier P. Gisbert, and Pilar received research funding from MSD, Abbvie, Pfizer, Kern Pharma, Nos. Guarantor of the article: Manuel Barreiro‐de Acosta and Takeda, Janssen, Ferring, Faes Farma, Shire Pharmaceuticals, Tillotts Pilar Nos. Pharma, Chiesi, and Otsuka Pharmaceutical. Yamile Zabana: has received support for conference attendance, speaker fees, research DA T A A V A I L A B I L I T Y S T A T E M E N T support and consulting fees of Abvvie, Adacyte, Almirall, Amgen, Dr The datasets generated during and/or analysed during the current Falk, FAES Pharma, Ferring, Jannsen, MSD, Otsuka, Pfizer, Shire, study are available at https://geteccu.org. Takeda, and Tillots. Belén Beltrán has served as a speaker, or has received research or education funding or advisory fees from MSD, OR CI D Abbvie, Pfizer, Takeda, Ferring, Otsuka, and Amgen. Xavier Calvet: has Manuel Barreiro‐de Acosta https://orcid.org/0000-0001-5915- received grants for research and fees for advisory boards and has 1477 given lectures for Abott, MSD, Vifor, Takeda, Pfizer, Janssen, and Eugeni Domènech https://orcid.org/0000-0002-2315-7196 Allergan. María Chaparro has served as a speaker, or has received Javier P. Gisbert https://orcid.org/0000-0003-2090-3445 research or education funding or advisory fees from MSD, Abbvie, Hospira, Pfizer, Takeda, Janssen, Ferring, Shire Pharmaceuticals, Dr. RE F E R E NC E S Falk Pharma, and Tillotts Pharma. Eugeni Domènech: has served as a 1. Chaparro M, Barreiro‐de Acosta M, Benítez JM, Cabriada JL, speaker, or has received research or education funding or advisory Casanova MJ, Ceballos D, et al. EpidemIBD: rationale and design of a fees from Samsung, MSD, AbbVie, Takeda, Kern Pharma, Pfizer, large‐scale epidemiological study of inflammatory bowel disease in Spain. Therap Adv Gastroenterol. 2019;12:1756284819847034. Janssen, Celgene, Adacyte Therapeutics, Roche, Otsuka Pharmaceu- https://doi.org/10.1177/1756284819847034 ticals, Ferring, Shire Pharmaceuticals, Tillots, Thermofisher, Grifols, 2. Brunet E, Vela E, Melcarne L, Clèries M, Pontes C, Llovet L, et al. Time Gebro, and Gilead. Maria Esteve: has received support for conference trends of Crohn’s disease in Catalonia from 2011 to 2017. Increasing attendance, speaker fees, research support, and consulting fees of use of biologics correlates with a reduced need for surgery. J Clin Med. 2020;9(9):2896. https://doi.org/10.3390/jcm9092896 Abvvie, Ferring, Jannsen, MSD, Otsuka, Pfizer, Takeda, and Tillots. 3. Beard JA, Click BH. The burden of cost in inflammatory bowel dis- Julian Panés has received financial support for research: AbbVie MSD ease: a medical economic perspective. Curr Opin Gastroenterol. and Pfizer; lecture fee(s): AbbVie, Ferring, Janssen, MSD, Pfizer, Shire 2020;36(4):310–6. https://doi.org/10.1097/MOG.0000000000000642 Pharmaceuticals, Takeda, and Theravance; consultancy: AbbVie, 4. Louis E, Dotan I, Ghosh S, Mlynarsky L, Reenaers C, Schreiber S. Optimising the inflammatory bowel disease unit to improve qual- Arena Pharmaceuticals, Boehringer Ingelheim, Celgene, Ferring, Gal- ity of care: expert recommendations. J Crohns Colitis. apagos, Genentech, GoodGut, GSK, Janssen, Mirum, Origo, Pandion, 2015;9(8):685–91. https://doi.org/10.1093/ecco‐jcc/jjv085 Pfizer, Progenity, Takeda, Theravance, and Wasserman. Javier P. 5. O’Connor M, Bager P, Duncan J, Gaarenstroom J, Younge L, Détré P, Gisbert: has served as a speaker, a consultant, and advisory member et al. N‐ECCO Consensus statements on the European nursing roles in caring for patients with Crohn’s disease or ulcerative colitis. J for or has received research funding from MSD, Abbvie, Hospira, Crohns Colitis. 2013;7(9):744–64. https://doi.org/10.1016/j.crohns. Pfizer, Kern Pharma, Biogen, Takeda, Janssen, Roche, Sandoz, Celgene, 2013.06.004 Ferring, Faes Farma, Shire Pharmaceuticals, Dr. Falk Pharma, Tillotts 6. Calvet X, Panés J, Alfaro N, Hinojosa J, Sicilia B, Gallego M, et al. Pharma, Chiesi, Casen Fleet, Gebro Pharma, Otsuka Pharmaceutical, Delphi consensus statement: quality indicators for inflammatory bowel disease comprehensive care units. J Crohns Colitis. and Vifor Pharma. Pilar Nos has served as a speaker, a consultant, and 2014;8(3):240–51. https://doi.org/10.1016/j.crohns.2013.10.010 advisory member for or has received research funding from MSD, 7. Waje‐Andreassen U, Nabavi DG, Engelter ST, Dippel D, Jenkinson D, Abbvie, Pfizer, Kern Pharma, Takeda, Janssen, Ferring, Faes Farma, Skoda O, et al. European Stroke Organisation certification of stroke Tillotts Pharma, and Otsuka Pharmaceutical. units and stroke centres. Eur Stroke J. 2018;3(3):220–26. https:// doi.org/10.1177/2396987318778971 8. Feuerstein JD, Castillo NE, Siddique SS, Lewandowski JJ, Geissler K, A U TH O R C O N TR IB UT I O N S Martinez‐Vazquez M, et al. Poor documentation of inflammatory Study concept and design: Manuel Barreiro‐de Acosta and Pilar Nos. bowel disease quality measures in academic, community, and private Analysis and interpretation of data: Manuel Barreiro‐de Acosta, Ana practice. Clin Gastroenterol Hepatol. 2016;14(3):421–28. https:// Gutiérrez, and Yamile Zabana. Drafting of the manuscript: Manuel doi.org/10.1016/j.cgh.2015.09.042 9. Strohl M, Gonczi L, Kurt Z, Bessissow T, Lakatos PL. Quality of care Barreiro‐de Acosta, Ana Gutiérrez, Yamile Zabana, and Pilar Nos. in inflammatory bowel diseases: what is the best way to better Members of Steering Committee Xavier Calvet, María Chaparro, outcomes? World J Gastroenterol. 2018;24(22):2363–72. https:// Eugeni Domènech, Maria Esteve, Julian Panés, and Javier P. Gisbert. doi.org/10.3748/wjg.v24.i22.2363 772 - UNITED EUROPEAN GASTROENTEROLOGY JOURNAL 10. Weaver KN, Kappelman MD, Sandler RS, Martin CF, Chen W, Anton disease standards of care. Clin Exp Gastroenterol. 2020;13:285–92. K, et al. Variation in care of inflammatory bowel diseases patients in https://doi.org/10.2147/CEG.S259790 Crohn’s and Colitis Foundation of America partners: role of 20. Massuger W, Moore GTC, Andrews JM, Kilkenny MF, Reyneke M, gastroenterologist practice setting in disease outcomes and quality Knowles S, et al. Crohn’s & Colitis Australia inflammatory bowel process measures. Inflamm Bowel Dis. 2016;22(11):2672–7. https:// disease audit: measuring the quality of care in Australia. Intern Med doi.org/10.1097/MIB.0000000000000933 J. 2019;49(7):859–866. https://doi.org/10.1111/imj.14187 11. Peña‐Sánchez JN, Lix LM, Teare GF, Li W, Fowler SA, Jones JL. 21. Mortier K, Protheroe A, Murray S. Improving the quality of care for Impact of an integrated model of care on outcomes of patients with people with inflammatory bowel disease (IBD): results of a national inflammatory bowel diseases: evidence from a population‐based audit. Future Hosp J. 2015;2(Suppl 2):s11. https://doi.org/10.7861/ study. J Crohns Colitis. 2017;11(12):1471–9. https://doi.org/10. futurehosp.2‐2s‐s11 1093/ecco‐jcc/jjx106 22. Alrubaiy L, Arnott I, Protheroe A, Roughton M, Driscoll R, Williams 12. Lönnfors S, Vermeire S, Greco M, Hommes D, Bell C, Avedano L. IBD JG. Inflammatory bowel disease in the UK: is quality of care and health‐related quality of life ‐‐ discovering the true impact. J improving? Frontline Gastroenterol. 2013;4(4):296–301. https://doi. Crohns Colitis. 2014;8(10):1281–6. https://doi.org/10.1016/j. org/10.1136/flgastro‐2013‐100333 crohns.2014.03.005 23. Negreanu L, Bataga S, Cijevschi Prelipcean C, Dobry D, Diculescu M, 13. Jackson BD, Con D, Liew D, De Cruz P. Clinicians’ adherence to Dumitru E, et al. Excellence centers in inflammatory bowel disease in international guidelines in the clinical care of adults with inflam- Romania: a measure of the quality of care. J Gastrointestin Liver Dis. matory bowel disease. Scand J Gastroenterol. 2017;52(5):536–42. 2014;23(3):333–7. https://doi.org/10.15403/jgld.2014.1121.233.ln1 https://doi.org/10.1080/00365521.2017.1278785 24. Curtis JR, Chen L, Higginbotham P, Nowell B, Gal‐Ley R, Willing J, 14. Ananthakrishnan AN, Kwon J, Raffals L, Sands B, Stenson WF, et al. Social media for arthritis‐related comparative effectiveness McGovern D, et al. Variation in treatment of patients with inflam- and safety research and the impact of direct‐to‐consumer adver- matory bowel diseases at major referral centers in the United States. tising. Arthritis Res Ther. 2017;19(1):48. https://doi.org/10.1186/ Clin Gastroenterol Hepatol. 2015;13(6):1197–200. https://doi.org/ s13075‐017‐1251‐y 10.1016/j.cgh.2014.11.020 25. Park KT, Ehrlich OG, Allen JI, Meadows P, Szigethy EM, Henrichsen 15. Melmed GY, Siegel CA, Spiegel BM, Allen JI, Cima R, Colombel JF, K, et al. The cost of inflammatory bowel disease: an initiative from et al. Quality indicators for inflammatory bowel disease: develop- the Crohn’s & Colitis Foundation. Inflamm Bowel Dis. ment of process and outcome measures. Inflamm Bowel Dis. 2020;26(1):1–10. https://doi.org/10.1093/ibd/izz104 2013;19(3):662–8. https://doi.org/10.1097/mib.0b013e3182 8278a2 16. Nguyen GC, Devlin SM, Afif W, Bressler B, Gruchy SE, Kaplan GG, S U P P O R T I N G I N F O RM A T I O N et al. Defining quality indicators for best‐practice management of Additional supporting information may be found online in the Sup- inflammatory bowel disease in Canada. Can J Gastroenterol Hep- porting Information section at the end of this article. atol. 2014;28(5):275–85. https://doi.org/10.1155/2014/941245 17. Fiorino G, Lytras T, Younge L, Fidalgo C, Coenen S, Chaparro M, et al. Quality of care standards in inflammatory bowel diseases: a How to cite this article: Barreiro‐de Acosta M, Gutiérrez A, European Crohn’s and Colitis Organisation [ECCO] position paper. J Crohns Colitis. 2020;14(8):1037–48. https://doi.org/10.1093/ecco‐ Zabana Y, Beltrán B, Calvet X, Chaparro M, et al. jcc/jjaa023 Inflammatory bowel disease integral care units: evaluation of 18. Shah R, Hou JK. Approaches to improve quality of care in inflamma- a nationwide quality certification programme. The GETECCU tory bowel diseases. World J Gastroenterol. 2014;20(28): experience. United European Gastroenterol J. 2021;9(7):766– 9281–5. https://doi.org/10.3748/wjg.v20.i28.9281 19. Hackett R, Gearry R, Ho C, McCombie A, Mackay M, Murdoch K, 772. https://doi.org/10.1002/ueg2.12105 et al. New Zealand National Audit of outpatient inflammatory bowel