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Intercenter variation in initial management of children with Crohn's disease

Michael D Kappelman1, Athos Bousvaros, Jeffrey Hyams

  • 1Center for Inflammatory Bowel Disease, Division of Gastroenterology and Nutrition, Children's Hospital Boston, Massachusetts 02115, USA. michael.kappelman@childrens.harvard.edu

Inflammatory Bowel Diseases
|February 9, 2007
PubMed

Insights

Pediatric Crohn's disease treatment varies significantly between centers, even after accounting for patient differences. This variation in managing pediatric Crohn's disease may impact healthcare costs and patient outcomes.

Area of Science:

  • Pediatric Gastroenterology
  • Clinical Outcomes Research

Background:

  • Healthcare variation is common and impacts costs, quality, and outcomes.
  • Intercenter variation in managing pediatric Crohn's disease is not well understood.

Purpose of the Study:

  • To quantify intercenter variation in the initial management of newly diagnosed pediatric Crohn's disease.
  • To identify factors contributing to treatment variation in pediatric Crohn's disease.

Main Methods:

  • Analysis of medication utilization (immunomodulators, prednisone, antibiotics, 5-aminosalicylates, infliximab) in 311 children across 10 North American centers.
  • Multivariate logistic regression adjusted for age, sex, race, disease severity, and location.
  • Comparison of medication use rates between centers for newly diagnosed Crohn's disease.

Main Results:

  • Significant intercenter variation observed for all 5 medication classes (P < 0.001 for 4, P = 0.02 for infliximab).
  • Median utilization rates varied widely: immunomodulators (56%), prednisone (78%), antibiotics (29%), 5-aminosalicylates (63.5%), and infliximab (7.5%).
  • Variation persisted after adjusting for demographic and clinical factors, though infliximab analysis was limited.

Conclusions:

  • Substantial intercenter variation exists in the initial medical management of pediatric Crohn's disease.
  • This variation is present even when accounting for patient case mix differences.
  • Observed treatment disparities may lead to unintended variations in healthcare costs and patient outcomes.
Abstract

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