Variation in Care in Pediatric Crohn Disease

• DOI: 10.1097/mpg.0b013e3181919695
• Publication Date: 2009-08-24T07:12:00Z
• Authors: 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 D Pfefferkorn; M Azim Qureshi
• Keywords: Thiopurine methyltransferase

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