A prospective cohort study of practice guidelines in inflammatory bowel disease

OBJECTIVES: Practice guidelines should improve care, but they are not routi nely followed, in part because of lack of proven benefit. We evaluated the effect of introducing guidelines for inflammatory bowel disease (MD) on pra ctice variation and the IBD Quality of Life (IBDQ) score. METHODS: This was a prospective, controlled, cohort study. A total of 65 pa tients were matched according to month of visit, diagnosis, and disease act ivity with control subjects seen 1 yr earlier. Physicians were educated thr oughout the study regarding the guidelines. Variation was measured by the M ayo Practice Guideline Score (MPGS), a 15-point assessment of documentation of diagnosis. nutrition, social support, education, functional status, and treatment. The IBDQ was measured at baseline and at 1 yr in the interventi on group and after 1 yr in the control group. RESULTS: The MPGS was significantly higher in the intervention group compar ed to the controls (p == 0.002), with median values of 12 versus 11. The IB DQ median score increased significantly in the intervention group (p < 0.00 1), baseline median of 133 versus 15-month median of 184. However, the fina l IBDQ was not significantly higher in the intervention group than in the c ontrols (p = 0.33). CONCLUSIONS: Practice guidelines for IBD reduce practice variation. The qua lity of life improved significantly compared to baseline with practice guid elines, but not compared to controls, perhaps because of the small sample s ize and homogenous practice setting. The MPGS is a tool that can be used in day-to-day management of IBD patients. (C) 2001 by Am. Coll. of Gastroente rology.