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      Consensus standards of healthcare for adults and children with inflammatory bowel disease in the UK

      research-article
      1 , , 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 16 , 21 , 22 , 23 , 8 , 24 , 3 , 25 , 26 , 10 , 27 , 16 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 10 , 35 , 22 , 36
      Frontline Gastroenterology
      BMJ Publishing Group
      inflammatory bowel disease, IBD, colitis, ulcerative colitis, UC, Crohn’s disease, CD, guideline, standards, quality improvement, multidisciplinary team, MDT, audit, cost-effectiveness, service development, pathway, protocol, patient education, self-management, benchmark, paediatrics, gastroenterology

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          Abstract

          Objective

          Symptoms and clinical course during inflammatory bowel disease (IBD) vary among individuals. Personalised care is therefore essential to effective management, delivered by a strong patient-centred multidisciplinary team, working within a well-designed service. This study aimed to fully rewrite the UK Standards for the healthcare of adults and children with IBD, and to develop an IBD Service Benchmarking Tool to support current and future personalised care models.

          Design

          Led by IBD UK, a national multidisciplinary alliance of patients and nominated representatives from all major stakeholders in IBD care, Standards requirements were defined by survey data collated from 689 patients and 151 healthcare professionals. Standards were drafted and refined over three rounds of modified electronic-Delphi.

          Results

          Consensus was achieved for 59 Standards covering seven clinical domains; (1) design and delivery of the multidisciplinary IBD service; (2) prediagnostic referral pathways, protocols and timeframes; (3) holistic care of the newly diagnosed patient; (4) flare management to support patient empowerment, self-management and access to specialists where required; (5) surgery including appropriate expertise, preoperative information, psychological support and postoperative care; (6) inpatient medical care delivery (7) and ongoing long-term care in the outpatient department and primary care setting including shared care. Using these patient-centred Standards and informed by the IBD Quality Improvement Project (IBDQIP), this paper presents a national benchmarking framework.

          Conclusions

          The Standards and Benchmarking Tool provide a framework for healthcare providers and patients to rate the quality of their service. This will recognise excellent care, and promote quality improvement, audit and service development in IBD.

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          Most cited references11

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          IBD and health-related quality of life — Discovering the true impact

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            A UK cost of care model for inflammatory bowel disease

            Objectives There are an estimated 620 000 patients with inflammatory bowel disease (IBD) in the UK. The rising incidence of IBD combined with its incurability has significant cost implications. The aim of this cost of care model was to calculate the annual cost per adult patient of treating ulcerative colitis (UC) and Crohn's disease (CD) from a NHS perspective, and to enable areas of potential cost savings to be explored. Design The cost of IBD was calculated by summing the costs of treatment, treatment side effects and disease-related complications, accounting for the proportions of patients incurring these costs. Default input values for costs, the percentage of patients receiving each treatment, and the percentage of patients experiencing treatment-related side effects or disease-related complications were determined from national sources and published literature. However, the model permitted the user to input local or alternative data. Setting The model was designed to be used by NHS trusts in the UK. Results Using default input values, the annual cost of treating any patient with UC was estimated to be £3084. For a patient with UC in remission, in relapse with mild-to-moderate UC or in relapse with severe UC, annual cost per patient was estimated to be £1693, £2903 and £10 760, respectively. The annual cost for any patient with CD was estimated to be £6156 (£1800 for patients in remission; £10 513 for patients in relapse). Conclusions While IBD remains a costly condition with modest potential cost savings, this model facilitates calculation of annual costs per patient with UC and CD, and its customisability will help hospitals identify areas where savings could be made.
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              The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

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                Author and article information

                Journal
                Frontline Gastroenterol
                Frontline Gastroenterol
                flgastro
                fg
                Frontline Gastroenterology
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2041-4137
                2041-4145
                2020
                24 July 2019
                24 July 2019
                : 11
                : 3
                : 178-187
                Affiliations
                [1 ] Crohn's & Colitis UK , Hatfield, UK
                [2 ] Newcastle University , Newcastle upon Tyne, UK
                [3 ] Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne, UK
                [4 ] Nottingham University Hospitals NHS Trust , Nottingham, UK
                [5 ] Mendip Vale Medical Practice , Yatton, UK
                [6 ] Western General Hospital , Edinburgh, UK
                [7 ] New Road Surgery , Rickmansworth, UK
                [8 ] IBD UK , Hatfield, UK
                [9 ] Frimley Health NHS Foundation Trust , Frimley, UK
                [10 ] University College London Hospitals NHS Foundation Trust , London, UK
                [11 ] Royal Wolverhampton Hospitals NHS Trust , Wolverhampton, UK
                [12 ] University of Wolverhampton , Wolverhampton, UK
                [13 ] Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield, UK
                [14 ] University Hospitals Coventry and Warwickshire NHS Trust , Coventry, UK
                [15 ] British Dietetic Association , Birmingham, UK
                [16 ] St Mark's Hospital , Harrow, UK
                [17 ] Southampton University NHS Trust , Southampton, UK
                [18 ] Addenbrooke's Hospital , Cambridge, Cambridgeshire, UK
                [19 ] Ileostomy & Internal Pouch Association , Essex, UK
                [20 ] Chelsea and Westminster Hospital NHS Foundation Trust , London, UK
                [21 ] Imperial College London , London, UK
                [22 ] Barts Health NHS Trust , London, UK
                [23 ] Queen Mary University of London , London, UK
                [24 ] Royal Hospital for Children , Glasgow, UK
                [25 ] Great North Children's Hospital , Newcastle upon Tyne, UK
                [26 ] Luton and Dunstable University Hospital NHS Foundation Trust , Luton, UK
                [27 ] The Pennine Acute Hospitals NHS Trust , Manchester, UK
                [28 ] University of Hertfordshire , Hatfield, UK
                [29 ] Birmingham Children's Hospital NHS Foundation Trust , Birmingham, UK
                [30 ] Craigavon Area Hospital , Portadown, Armagh, UK
                [31 ] CICRA , Sutton, UK
                [32 ] University of Sheffield , Sheffield, UK
                [33 ] Gloucestershire Hospitals NHS Foundation Trust , Cheltenham, UK
                [34 ] Brighton and Sussex University Hospitals NHS Trust , Brighton, UK
                [35 ] Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust , Bournemouth, UK
                [36 ] University Hospital of Wales , Cardiff, UK
                Author notes
                [Correspondence to ] Ms Rukshana Kapasi, Crohn's & Colitis UK, Hatfield, UK; rukshana.kapasi@ 123456crohnsandcolitis.org.uk
                Author information
                http://orcid.org/0000-0002-6593-167X
                http://orcid.org/0000-0002-0785-1815
                http://orcid.org/0000-0001-6107-8109
                Article
                flgastro-2019-101260
                10.1136/flgastro-2019-101260
                7223296
                32419908
                721262b4-ab84-4557-bb19-db423f0f6bcc
                © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 10 May 2019
                : 31 May 2019
                : 04 June 2019
                Categories
                Professional Matters
                1506
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                Gastroenterology & Hepatology
                inflammatory bowel disease,ibd,colitis,ulcerative colitis,uc,crohn’s disease,cd,guideline,standards,quality improvement,multidisciplinary team,mdt,audit,cost-effectiveness,service development,pathway,protocol,patient education,self-management,benchmark,paediatrics,gastroenterology

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