(P005) QUALITY IMPROVEMENT EFFORT TO DECREASE NUMBER OF DAYS TO INFUSED THERAPY INITIATION FOR PATIENTS WITH INFLAMMATORY BOWEL DISEASE

BACKGROUND

Several advanced therapies for inflammatory bowel disease (IBD) are infused medications. Payers increasingly prefer the infusion of biologic therapies at free-standing infusion centers (FSICs), rather than hospital-associated infusion centers (HAICs). We aimed to assess the time to initiate therapy after clinical decision to start an infused medication, and to map the process of infusion initiation to identify opportunities for quality improvement (QI). 

METHODS

Our clinic participates in IBD-Qorus, a multicenter QI network focused on assessing the uptake of treat-to-target in real-world settings. We used QI methods (the Model for Improvement, Institute for Healthcare Improvement, Boston, MA) including Plan-Do-Study-Act (PDSA) cycles to evaluate data on a subset of randomly selected patients who received infused biologic therapies between April 2023 and August 2024. We performed a retrospective analysis comparing the number of days to therapy at our HAIC relative to FSICs. We then created a process map and divided it into three phases: (1) time to select a FSIC if not able to be infused at our HAIC, (2) time from selection of FSIC to receipt of prescriber orders, and (3) time from order receipt to receipt of first dose.

RESULTS

We assessed 43 patients, referred for initiation of infliximab (12%), vedolizumab (14%), ustekinumab (14%), and risankizumab (60%). 76% had Crohn’s disease and 23% had ulcerative colitis. 26% had coverage under Medicare and 74% had private insurance. 74% received therapy at HAIC and 26% at FSICs. The average number of days to therapy was 20 days at our HAIC (range: 2 days to 92 days) and 39 days at FSIC (range: 11 days to 80 days). We developed a process map consisting of 7 steps for referrals to our HAIC and 16 steps for referrals to FSICs (see Figure).

CONCLUSIONS

The time to initiate an infusion at FSIC is approximately twice that of an infusion at our HAIC. Delays in patient care can lead to disease exacerbation and complications. Future QI initiatives can address areas defined by process mapping to reduce the time for therapy initiation after a treatment decision is made.