Journal article
Variation in Care in Pediatric Crohn Disease
Journal of pediatric gastroenterology and nutrition, Vol.49(3), pp.297-303
2009
DOI: 10.1097/MPG.0b013e3181919695
PMID: 19590456
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.
Details
- Title: Subtitle
- Variation in Care in Pediatric Crohn Disease
- Creators
- Richard B COLLETTI - University of Vermont, Burlington, VT, United StatesRobert N BALDASSANO - Children's Hospital of Philadelphia, Philadelphia, PA, United StatesMarla DUBINSKY - Cedars-Sinai Medical Center, Los Angeles, CA, United StatesDawn R EBACH - University of Iowa, Iowa City, IA, United StatesEdward J HOFFENBERG - University of Colorado, Denver, CO, United StatesHoward A KADER - Sinai Hospital of Baltimore, Baltimore, MD, United StatesDavid J KELJO - Children's Hospital of Pittsburgh, Pittsburgh, PA, United StatesIan H LEIBOWITZ - INOVA, Fairfax, VA, United StatesPetar MAMULA - Children's Hospital of Philadelphia, Philadelphia, PA, United StatesMarian D PFEFFERKORN - Riley Hospital for Children, Indianapolis, IN, United StatesM Azim Qureshi - Penn State Children's Hospital, Hershey, PA, United StatesDavid E MILOV - Nemours Children's Clinics, Orlando, FL, United StatesPeter A MARGOLIS - Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United StatesAthos BOUSVAROS - Children's Hospital, Boston, MA, United StatesWallace V CRANDALL - Nationwide Children's Hospital, Columbus, OH, United StatesKaren D CRISSINGER - University of South Alabama, Mobile, United StatesMichael A D'AMICO - University of Vermont, Burlington, VT, United StatesAndrew S DAY - Sydney Children's Hospital, Sydney, AustraliaLee A DENSON - Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United StatesPediatric IBD Network for Research and Improvement
- Resource Type
- Journal article
- Publication Details
- Journal of pediatric gastroenterology and nutrition, Vol.49(3), pp.297-303
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/MPG.0b013e3181919695
- PMID
- 19590456
- ISSN
- 0277-2116
- eISSN
- 1536-4801
- Language
- English
- Date published
- 2009
- Academic Unit
- Stead Family Department of Pediatrics; Gastroenterology, Hepatology, Pancreatology, and Nutrition
- Record Identifier
- 9984093215402771
Metrics
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