To determine the potential effectiveness of programs such as ImproveCareNow, it's important to understand how care is provided in the absense of such programs. The study found that there are significant variations in care, and that gaps exist between recommended and actual care.  An abstract of the study is provided below, followed by a link to the full article on the Journal of Pediatric Gastroenterology and Nutrition web site.

Variation in Care in Pediatric Crohn's 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 D; Qureshi, M Azim; for PIBDNet, the Pediatric IBD Network for Research and Improvement (now named Improve Care Now)

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.

Journal of Pediatric Gastroenterology and Nutrition:
September 2009 - Volume 49 - Issue 3 - p 297-303

Link to full article:
Please click here to read the story in the Journal of Pediatric Gastroenterology and Nutrition in a new browser window.


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