title: Variation in treatment of patients with inflammatory bowel diseases at major referral centers in the United States.
abstract: 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.
authors.affiliation: Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: aananthakrishnan@mgh.harvard.edu.
authors.forename: Ashwin N
authors.initials: AN
authors.lastname: Ananthakrishnan
authors.affiliation: Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kwon
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Laura
authors.initials: L
authors.lastname: Raffals
authors.affiliation: Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Bruce
authors.initials: B
authors.lastname: Sands
authors.affiliation: Division of Gastroenterology, Washington University, St. Louis, Missouri.
authors.forename: William F
authors.initials: WF
authors.lastname: Stenson
authors.affiliation: Inflammatory Bowel Disease and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Dermot
authors.initials: D
authors.lastname: McGovern
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, Illinois.
authors.forename: John H
authors.initials: JH
authors.lastname: Kwon
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Rheaume
authors.affiliation: Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery*; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery*; D004358:Drug Therapy / Q000379:methods* / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D007155:Immunologic Factors
keywords: Anti-TNF Agent; IBD; Practice Variation; Sinai Helmsley Alliance for Research Excellence (SHARE) Consortium