title: There is Significant Practice Pattern Variability in the Management of the Hospitalized Ulcerative Colitis Patient at a Tertiary Care and IBD Referral Center.
abstract: Despite published clinical guidelines, substantive data underlying the approach to the management of hospitalized ulcerative colitis (UC) patients failing outpatient therapy are lacking. Variability in practice is therefore not uncommon and may impact clinical outcomes. The degree of variability, however, is not well-studied. Our aim was to evaluate variability in management of the hospitalized UC patient to inform future efforts targeting care optimization for this high-risk population.
  
  
  
  An internet survey was distributed among inflammatory bowel disease providers, which included: (1) nonvignette-based questions assessing provider demographics, experience, and practice setting; (2) diagnostic and therapeutic practice patterns based on a vignette of a hospitalized UC patient. Descriptive and univariate analyses were performed.
  
  
  
  Ninety-one percent of eligible individuals were included. Nearly 97% endorsed confidence in management of hospitalized UC patients. In general, 83% initiate intravenous corticosteroids (IVCS) as initial therapy, whereas 17% initiate infliximab (IFX) (+/-IVCS). At IVCS failure in the vignette, 74% initiated IFX, 15% increased IVCS dose, 7% initiated cyclosporine, and 4% chose colectomy. Of those choosing IFX, 65% chose 5 mg/kg as the initial dose, whereas the remainder chose 10 mg/kg. Twenty-eight percent gave an additional IFX 5 mg/kg and 7% gave an additional 10 mg/kg dose to the patient in the vignette not responding to 5 mg/kg.
  
  
  
  Even among experienced inflammatory bowel disease providers, there is significant practice pattern variability in the management of hospitalized UC patients. Future efforts should target this variability. Adjunctively, prospective trials are needed to guide appropriate therapeutic algorithms, especially with respect to positioning and optimally dosing IFX in this population.
authors.affiliation: The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Shailja C
authors.initials: SC
authors.lastname: Shah
authors.forename: Steven
authors.initials: S
authors.lastname: Naymagon
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Cohen
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Sands
authors.forename: Marla C
authors.initials: MC
authors.lastname: Dubinsky
mesh_terms: D000328:Adult; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000628:therapy*; D019091:Critical Pathways; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000069285:Infliximab / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D009519:New York City; D010343:Patient Admission; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000069285:Infliximab