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Quality improvement project identifies factors associated with delay in IBD diagnosis
Author(s) -
Walker Gareth J.,
Lin Simeng,
Chanchlani Neil,
Thomas Amanda,
Hendy Peter,
Heerasing Neel,
Moore Lucy,
Green Harry D.,
Chee Desmond,
Bewshea Claire,
Mays Joseph,
Kennedy Nicholas A.,
Ahmad Tariq,
Goodhand James R.
Publication year - 2020
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.15885
Subject(s) - medicine , referral , ulcerative colitis , inflammatory bowel disease , disease , pediatrics , quartile , presentation (obstetrics) , crohn's disease , surgery , confidence interval , family medicine
Summary Background Delay in the diagnosis of inflammatory bowel disease (IBD) is common and contemporary UK studies are lacking. Aim To determine factors associated with, and the consequences of, a prolonged time to diagnosis in IBD. Methods This quality improvement study included 304 adults with a new IBD diagnosis made between January 2014 and December 2017 across 49 general practices (GP) and gastroenterology secondary care services. Outcome measures were demographic, clinical and laboratory factors associated with a delayed time, defined as greater than upper quartile, to: (a) patient presentation (b) GP referral (c) secondary care diagnosis, and factors associated with a complicated disease course (hospitalisation and/or surgery and/or biologic treatment) in the year after diagnosis. Results The median [IQR] diagnosis sub‐intervals were: (a) patient = 2.1 months [0.9‐5.1]; (b) GP = 0.3 months [0.0‐0.9]; (c) secondary care = 1.1 months [0.5‐2.1]. 50% of patients were diagnosed within 4 months and 92% were diagnosed within 2 years of symptom onset. Diagnostic delay was more common in Crohn's disease (7.6 months [3.1‐15.0]) than ulcerative colitis (3.3 months [1.9‐7.3]) ( P < 0.001). Patients who presented as an emergency ( P < 0.001) but not those with a delayed overall time to diagnosis ( P = 0.35) were more likely to have a complicated disease course. Conclusion Time to patient presentation is the largest component of time to IBD diagnosis. Emergency presentation is common and, unlike a delayed time to diagnosis, is associated with a complicated disease course.