Variation in care in pediatric crohn disease

Richard B. Colletti, Robert N. Baldassano, David E. Milov, Peter A. Margolis, Athos Bousvaros, Wallace V. Crandall, Karen D. Crissinger, Michael A. D'Amico, Andrew S. Day, Lee A. Denson, Marla Dubinsky, Dawn R. Ebach, Edward J. Hoffenberg, Howard A. Kader, David J. Keljo, Ian H. Leibowitz, Petar Mamula, Marian Pfefferkorn, M. Azim Qureshi

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Objectives: Variation in medical care can be a barrier to improving clinical outcomes. We aim to describe the variation in care of Crohn disease as provided by a broad sample of pediatric gastroenterologists. Methods: Two hundred forty-six Crohn disease patients of 93 pediatric gastroenterologists from 48 practice sites starting treatment with either thiopurine or infliximab were studied. We assessed variation in diagnostic testing that had been performed to establish the diagnosis of Crohn disease and to assess the phenotype, extent, and severity of disease. We also assessed variation in initial thiopurine and infliximab dosage and in nutritional therapy. Results: Diagnostic studies in which care was uniform included complete blood count, performed in 100% of patients, erythrocyte sedimentation rate and colonoscopy in 96%, and upper endoscopy in 89%. However, imaging of the small bowel had not been performed in 19%, and a stool test for pathogens had not been performed in 29%. Thiopurine methyltransferase (TPMT) had been measured in 61% of patients before treatment with a thiopurine; in 85%, TPMT was normal. Nonetheless, even when TPMT was normal, 40% of patients received an initial dose of thiopurine that was lower than recommended. Testing for tuberculosis before initiating treatment with infliximab was not performed in 30%. In addition, 36% of severely underweight patients were not receiving a multivitamin supplement, supplemental formula, or tube feeding. Conclusions: There is variation in diagnostic and therapeutic interventions in the management of pediatric Crohn disease, and gaps exist between recommended and actual care.

Original languageEnglish
Pages (from-to)297-303
Number of pages7
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume49
Issue number3
DOIs
StatePublished - Sep 2009

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thiopurine methyltransferase
Crohn Disease
Pediatrics
Therapeutics
Blood Cell Count
Thinness
Blood Sedimentation
Enteral Nutrition
Colonoscopy
Endoscopy
Tuberculosis
Pediatric Crohn's disease
Phenotype
Infliximab

Keywords

  • Crohn disease - Inflammatory bowel
  • Disease - Quality
  • Improvement - Variation in care

ASJC Scopus subject areas

  • Gastroenterology
  • Pediatrics, Perinatology, and Child Health

Cite this

Colletti, R. B., Baldassano, R. N., Milov, D. E., Margolis, P. A., Bousvaros, A., Crandall, W. V., ... Qureshi, M. A. (2009). Variation in care in pediatric crohn disease. Journal of Pediatric Gastroenterology and Nutrition, 49(3), 297-303. https://doi.org/10.1097/MPG.0b013e3181919695

Variation in care in pediatric crohn disease. / Colletti, Richard B.; Baldassano, Robert N.; Milov, David E.; Margolis, Peter A.; Bousvaros, Athos; Crandall, Wallace V.; Crissinger, Karen D.; D'Amico, Michael A.; Day, Andrew S.; Denson, Lee A.; Dubinsky, Marla; Ebach, Dawn R.; Hoffenberg, Edward J.; Kader, Howard A.; Keljo, David J.; Leibowitz, Ian H.; Mamula, Petar; Pfefferkorn, Marian; Qureshi, M. Azim.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 49, No. 3, 09.2009, p. 297-303.

Research output: Contribution to journalArticle

Colletti, RB, Baldassano, RN, Milov, DE, Margolis, PA, Bousvaros, A, Crandall, WV, Crissinger, KD, D'Amico, MA, Day, AS, Denson, LA, Dubinsky, M, Ebach, DR, Hoffenberg, EJ, Kader, HA, Keljo, DJ, Leibowitz, IH, Mamula, P, Pfefferkorn, M & Qureshi, MA 2009, 'Variation in care in pediatric crohn disease', Journal of Pediatric Gastroenterology and Nutrition, vol. 49, no. 3, pp. 297-303. https://doi.org/10.1097/MPG.0b013e3181919695
Colletti RB, Baldassano RN, Milov DE, Margolis PA, Bousvaros A, Crandall WV et al. Variation in care in pediatric crohn disease. Journal of Pediatric Gastroenterology and Nutrition. 2009 Sep;49(3):297-303. https://doi.org/10.1097/MPG.0b013e3181919695
Colletti, Richard B. ; Baldassano, Robert N. ; Milov, David E. ; Margolis, Peter A. ; Bousvaros, Athos ; Crandall, Wallace V. ; Crissinger, Karen D. ; D'Amico, Michael A. ; Day, Andrew S. ; Denson, Lee A. ; Dubinsky, Marla ; Ebach, Dawn R. ; Hoffenberg, Edward J. ; Kader, Howard A. ; Keljo, David J. ; Leibowitz, Ian H. ; Mamula, Petar ; Pfefferkorn, Marian ; Qureshi, M. Azim. / Variation in care in pediatric crohn disease. In: Journal of Pediatric Gastroenterology and Nutrition. 2009 ; Vol. 49, No. 3. pp. 297-303.
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AU - Denson, Lee A.

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AU - Ebach, Dawn R.

AU - Hoffenberg, Edward J.

AU - Kader, Howard A.

AU - Keljo, David J.

AU - Leibowitz, Ian H.

AU - Mamula, Petar

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KW - Disease - Quality

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