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

Michael D. Kappelman, Athos Bousvaros, Jeffrey Hyams, James Markowitz, Marian Pfefferkorn, Subra Kugathasan, Joel Rosh, Anthony Otley, David Mack, Anne Griffiths, Jonathan Evans, Richard Grand, Christine Langton, Ken Kleinman, Jonathan A. Finkelstein

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background: Variation in care is a ubiquitous feature of medical practice and may lead to significant differences in health care costs, quality, and outcomes. We undertook this study to determine the extent of intercenter variation in the initial management of children newly diagnosed with Crohn's disease. Methods: We analyzed the utilization of 5 classes of medication (immunomodulators, prednisone, antibiotics, 5-aminosalicylates, and infliximab) among 311 children with newly diagnosed Crohn's disease followed at 10 North American pediatric gastroenterology centers. Multivariate logistic regression was used to compare the utilization rate of each class of medication at each of the 10 centers, adjusting for potential confounders including patient age, sex, race, disease severity, and anatomic location of disease. Results: Median utilization of each class of medication was: immunomodulators, 56% (range 29%-97%); prednisone, 78% (range 32%-88%); antibiotics, 29% (range 11%-68%); 5-aminosalicylates, 63.5% (range 18%-92%); and infliximab, 7.5% (range 3%-21%). Each of these treatments showed statistically significant intercenter variation in utilization (P < 0.001 for immunomodulators, prednisone, antibiotics, and 5-ASA; P = 0.02 for infliximab). After adjusting for the demographic and clinical factors listed above, intercenter variation remained significant; however, the low utilization of infliximab precluded multivariate analysis. Conclusions: Widespread intercenter variation in the medical management of newly diagnosed children with Crohn's disease was observed, even after adjusting for possible differences in case mix between institutions. This variation may lead to unintended differences in health care costs and outcomes.

Original languageEnglish (US)
Pages (from-to)890-895
Number of pages6
JournalInflammatory bowel diseases
Volume13
Issue number7
DOIs
StatePublished - Jul 1 2007
Externally publishedYes

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Crohn Disease
Immunologic Factors
Prednisone
Mesalamine
Anti-Bacterial Agents
Health Care Costs
Diagnosis-Related Groups
Gastroenterology
Multivariate Analysis
Logistic Models
Demography
Pediatrics
Infliximab
Therapeutics

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Gastroenterology

Cite this

Kappelman, M. D., Bousvaros, A., Hyams, J., Markowitz, J., Pfefferkorn, M., Kugathasan, S., ... Finkelstein, J. A. (2007). Intercenter variation in initial management of children with Crohn's disease. Inflammatory bowel diseases, 13(7), 890-895. https://doi.org/10.1002/ibd.20121
Kappelman, Michael D. ; Bousvaros, Athos ; Hyams, Jeffrey ; Markowitz, James ; Pfefferkorn, Marian ; Kugathasan, Subra ; Rosh, Joel ; Otley, Anthony ; Mack, David ; Griffiths, Anne ; Evans, Jonathan ; Grand, Richard ; Langton, Christine ; Kleinman, Ken ; Finkelstein, Jonathan A. / Intercenter variation in initial management of children with Crohn's disease. In: Inflammatory bowel diseases. 2007 ; Vol. 13, No. 7. pp. 890-895.
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Kappelman, MD, Bousvaros, A, Hyams, J, Markowitz, J, Pfefferkorn, M, Kugathasan, S, Rosh, J, Otley, A, Mack, D, Griffiths, A, Evans, J, Grand, R, Langton, C, Kleinman, K & Finkelstein, JA 2007, 'Intercenter variation in initial management of children with Crohn's disease', Inflammatory bowel diseases, vol. 13, no. 7, pp. 890-895. https://doi.org/10.1002/ibd.20121

Intercenter variation in initial management of children with Crohn's disease. / Kappelman, Michael D.; Bousvaros, Athos; Hyams, Jeffrey; Markowitz, James; Pfefferkorn, Marian; Kugathasan, Subra; Rosh, Joel; Otley, Anthony; Mack, David; Griffiths, Anne; Evans, Jonathan; Grand, Richard; Langton, Christine; Kleinman, Ken; Finkelstein, Jonathan A.

In: Inflammatory bowel diseases, Vol. 13, No. 7, 01.07.2007, p. 890-895.

Research output: Contribution to journalArticle

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T1 - Intercenter variation in initial management of children with Crohn's disease

AU - Kappelman, Michael D.

AU - Bousvaros, Athos

AU - Hyams, Jeffrey

AU - Markowitz, James

AU - Pfefferkorn, Marian

AU - Kugathasan, Subra

AU - Rosh, Joel

AU - Otley, Anthony

AU - Mack, David

AU - Griffiths, Anne

AU - Evans, Jonathan

AU - Grand, Richard

AU - Langton, Christine

AU - Kleinman, Ken

AU - Finkelstein, Jonathan A.

PY - 2007/7/1

Y1 - 2007/7/1

N2 - Background: Variation in care is a ubiquitous feature of medical practice and may lead to significant differences in health care costs, quality, and outcomes. We undertook this study to determine the extent of intercenter variation in the initial management of children newly diagnosed with Crohn's disease. Methods: We analyzed the utilization of 5 classes of medication (immunomodulators, prednisone, antibiotics, 5-aminosalicylates, and infliximab) among 311 children with newly diagnosed Crohn's disease followed at 10 North American pediatric gastroenterology centers. Multivariate logistic regression was used to compare the utilization rate of each class of medication at each of the 10 centers, adjusting for potential confounders including patient age, sex, race, disease severity, and anatomic location of disease. Results: Median utilization of each class of medication was: immunomodulators, 56% (range 29%-97%); prednisone, 78% (range 32%-88%); antibiotics, 29% (range 11%-68%); 5-aminosalicylates, 63.5% (range 18%-92%); and infliximab, 7.5% (range 3%-21%). Each of these treatments showed statistically significant intercenter variation in utilization (P < 0.001 for immunomodulators, prednisone, antibiotics, and 5-ASA; P = 0.02 for infliximab). After adjusting for the demographic and clinical factors listed above, intercenter variation remained significant; however, the low utilization of infliximab precluded multivariate analysis. Conclusions: Widespread intercenter variation in the medical management of newly diagnosed children with Crohn's disease was observed, even after adjusting for possible differences in case mix between institutions. This variation may lead to unintended differences in health care costs and outcomes.

AB - Background: Variation in care is a ubiquitous feature of medical practice and may lead to significant differences in health care costs, quality, and outcomes. We undertook this study to determine the extent of intercenter variation in the initial management of children newly diagnosed with Crohn's disease. Methods: We analyzed the utilization of 5 classes of medication (immunomodulators, prednisone, antibiotics, 5-aminosalicylates, and infliximab) among 311 children with newly diagnosed Crohn's disease followed at 10 North American pediatric gastroenterology centers. Multivariate logistic regression was used to compare the utilization rate of each class of medication at each of the 10 centers, adjusting for potential confounders including patient age, sex, race, disease severity, and anatomic location of disease. Results: Median utilization of each class of medication was: immunomodulators, 56% (range 29%-97%); prednisone, 78% (range 32%-88%); antibiotics, 29% (range 11%-68%); 5-aminosalicylates, 63.5% (range 18%-92%); and infliximab, 7.5% (range 3%-21%). Each of these treatments showed statistically significant intercenter variation in utilization (P < 0.001 for immunomodulators, prednisone, antibiotics, and 5-ASA; P = 0.02 for infliximab). After adjusting for the demographic and clinical factors listed above, intercenter variation remained significant; however, the low utilization of infliximab precluded multivariate analysis. Conclusions: Widespread intercenter variation in the medical management of newly diagnosed children with Crohn's disease was observed, even after adjusting for possible differences in case mix between institutions. This variation may lead to unintended differences in health care costs and outcomes.

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Kappelman MD, Bousvaros A, Hyams J, Markowitz J, Pfefferkorn M, Kugathasan S et al. Intercenter variation in initial management of children with Crohn's disease. Inflammatory bowel diseases. 2007 Jul 1;13(7):890-895. https://doi.org/10.1002/ibd.20121