Variation in Care in Pediatric Crohn Disease

被引：50

作者：

Colletti, Richard B. ^{[1
]}

Baldassano, Robert N. ^{[2
]}

Milov, David E. ^{[3
]}

Margolis, Peter A. ^{[4
]}

Bousvaros, Athos ^{[5
]}

Crandall, Wallace V. ^{[6
]}

Crissinger, Karen D. ^{[7
]}

D'Amico, Michael A. ^{[1
]}

Day, Andrew S. ^{[8
]}

Denson, Lee A. ^{[4
]}

Dubinsky, Marla ^{[9
]}

Ebach, Dawn R. ^{[10
]}

Hoffenberg, Edward J. ^{[11
]}

Kader, Howard A. ^{[12
]}

Keljo, David J. ^{[13
]}

Leibowitz, Ian H. ^{[14
]}

Mamula, Petar ^{[2
]}

Pfefferkorn, Marian D. ^{[15
]}

Qureshi, M. Azim ^{[16
]}

机构：

[1] Univ Vermont, Burlington, VT 05405 USA

[2] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[3] Nemours Childrens Clin, Orlando, FL USA

[4] Cincinnati Childrens Hosp, Med Ctr, Cincinnati, OH USA

[5] Childrens Hosp, Boston, MA 02115 USA

[6] Nationwide Childrens Hosp, Columbus, OH USA

[7] Univ S Alabama, Mobile, AL 36688 USA

[8] Sydney Childrens Hosp, Sydney, NSW, Australia

[9] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA

[10] Univ Iowa, Iowa City, IA USA

[11] Univ Colorado, Denver, CO 80202 USA

[12] Sinai Hosp, Baltimore, MD 21215 USA

[13] Childrens Hosp Pittsburgh, Pittsburgh, PA 15213 USA

[14] INOVA, Fairfax, VA USA

[15] James Whitcomb Riley Hosp Children, Indianapolis, IN 46202 USA

[16] Penn State Childrens Hosp, Hershey, PA USA

来源：

JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION | 2009年 / 49卷 / 03期

关键词：

Crohn disease; Inflammatory bowel disease; Quality improvement; Variation in care; INFLAMMATORY-BOWEL-DISEASE; HEALTH-CARE; PRACTICE GUIDELINES; COST-EFFECTIVENESS; QUALITY; CLASSIFICATION; AZATHIOPRINE; ASSOCIATION; MANAGEMENT; CONSENSUS;

D O I：

10.1097/MPG.0b013e3181919695

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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. JPGN 49:297-303, 2009.

引用

页码：297 / 303

页数：7

共 30 条

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