Background Obesity is a significant public health threat to children in the United States. Aims 1) Determine the prevalence of obesity in a multi-center cohort of children with IBD; 2) Evaluate whether overweight and obese status is associated with patient demographics or disease characteristics. Methods We used data from the ImproveCareNow Collaborative for pediatric IBD, a multi-center registry of children with IBD, collected between April 2007 and December 2009. Children ages 2-18 years were classified into BMI percentiles. Bivariate analyses and multivariate logistic regression were used to compare demographic and disease characteristics by overweight (BMI>85%) and obese (BMI>95%) status. Results The population consisted of 1598 children with IBD. The prevalence of overweight/obese status in pediatric IBD is 23.6%, (20.0% for Crohn's disease (CD) and 30.1% for ulcerative colitis (UC) and indeterminate colitis (IC)). African American race (OR 1.64, 95% CI 1.10-2.48) and Medicaid insurance (OR 1.67, 95% CI 1.19-2.34) were positively associated with overweight/obese status. Prior IBD related surgery (OR 1.73, 95% CI 1.07-2.82) was also associated with overweight and obese status in children with CD. Other disease characteristics were not associated with overweight and obesity in children with IBD. Conclusions Approximately 1/5 of children with CD and 1/3 with UC are overweight or obese. Rates of obesity in UC are comparable to the general population. Obese IBD patients may have a more severe disease course, as indicated by increased need for surgery. Sociodemographic risk factors for obesity in the IBD population are similar to those in the general population.

These improvements suggest that practice sites are learning how to apply quality improvement methods to improve the care of patients.

Improvements in the outcomes of patients with CD and UC were associated with improvements in the process of chronic illness care. Variation in the success of implementing changes suggests the importance of overcoming organizational factors related to quality improvement success.

Background Practical and objective instruments to assess pediatric Crohn’s disease (CD) activity are required for observational research and quality improvement. Objectives 1) To determine the feasibility of completing the Pediatric Crohn’s Disease Activity Index (PCDAI) and the Abbreviated PCDAI (APCDAI), and 2) To create a short PCDAI by retaining and re-weighting the most practical and informative components. Methods Physicians in the ImproveCareNow Collaborative for pediatric inflammatory bowel disease (IBD) were asked to record components of the PCDAI and assign a Physician Global Assessment (PGA) of disease severity at each patient encounter. We assessed the feasibility of the PCDAI, the APCDAI, and the individual index components by determining the proportion of visits in which data were recorded. We created a short index by retaining and reweighting components of the PCDAI completed in ≥80% of visits. The feasibility of the short PCDAI and its ability to discriminate between PGA categories were evaluated using descriptive statistics. Results This study population included 1355 subjects with CD (6373 visits). The PCDAI and APCDAI were complete in 16.7% and 44.1% of visits respectively. A short PCDAI, including general well-being, abdominal pain, stools, weight, abdominal exam, and extra-intestinal manifestations could be completed in 66.5% of visits. The correlation between the Short PCDAI and PGA was similar to that of the PCDAI (r= 0.60, p<0.001 vs 0.61, p<0.001). Conclusion The Short PCDAI is a practical and valid tool to measure pediatric CD activity disease activity. Its use should facilitate quality improvement and observational research.

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