TY - JOUR
T1 - Variation in Treatment of Patients With Inflammatory Bowel Diseases at Major Referral Centers in the United States
AU - Ananthakrishnan, Ashwin N.
AU - Kwon, Jennifer
AU - Raffals, Laura
AU - Sands, Bruce
AU - Stenson, William F.
AU - McGovern, Dermot
AU - Kwon, John H.
AU - Rheaume, Robert L.
AU - Sandler, Robert S.
N1 - Publisher Copyright:
© 2015 AGA Institute.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - We performed a prospective study of patients with inflammatory bowel diseases to examine variations in treatment among medical centers. In a prospective cohort study of 1659 patients with Crohn's disease and 946 patients with ulcerative colitis seen at 7 high-volume referral centers, we collected data on demographics, disease characteristics, and medical and surgical treatments. We used logistic regression to determine differences in treatment among centers, controlling for potential confounders. We found significant variations among centers in the treatment of Crohn's disease with immunomodulators (odds ratio [OR], 3.34; 95% confidence interval [CI], 2.09-5.32) but not anti-tumor necrosis factor agents (OR, 1.64; 95% CI, 0.97-2.77). There was less variation in the treatment of ulcerative colitis; we found no difference in use of immunomodulators (OR, 1.83; 95% CI, 1.00-3.36) or anti-tumor necrosis factor therapy (OR, 0.81; 95% CI, 0.40-1.65). The development and implementation of evidence-based standards of care for inflammatory bowel disease may help reduce variation and improve outcomes.
AB - We performed a prospective study of patients with inflammatory bowel diseases to examine variations in treatment among medical centers. In a prospective cohort study of 1659 patients with Crohn's disease and 946 patients with ulcerative colitis seen at 7 high-volume referral centers, we collected data on demographics, disease characteristics, and medical and surgical treatments. We used logistic regression to determine differences in treatment among centers, controlling for potential confounders. We found significant variations among centers in the treatment of Crohn's disease with immunomodulators (odds ratio [OR], 3.34; 95% confidence interval [CI], 2.09-5.32) but not anti-tumor necrosis factor agents (OR, 1.64; 95% CI, 0.97-2.77). There was less variation in the treatment of ulcerative colitis; we found no difference in use of immunomodulators (OR, 1.83; 95% CI, 1.00-3.36) or anti-tumor necrosis factor therapy (OR, 0.81; 95% CI, 0.40-1.65). The development and implementation of evidence-based standards of care for inflammatory bowel disease may help reduce variation and improve outcomes.
KW - Anti-TNF Agent
KW - IBD
KW - Practice Variation
KW - Sinai Helmsley Alliance for Research Excellence (SHARE) Consortium
UR - http://www.scopus.com/inward/record.url?scp=84930375398&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2014.11.020
DO - 10.1016/j.cgh.2014.11.020
M3 - Article
C2 - 25460565
AN - SCOPUS:84930375398
SN - 1542-3565
VL - 13
SP - 1197
EP - 1200
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 6
ER -