Variation in Care in Pediatric Crohn Disease

Colletti, Richard B.; Baldassano, Robert N.; Milov, David E.; Margolis, Peter A.; Bousvaros, Athos; Crandall, Wallace; Crissinger, Karen D.; D'Amico, Michael; Day, Andrew S.; Denson, Lee A.; Dubinsky, Marla; Ebach, Dawn R.; Hoffenberg, Edward J.; Kader, Howard A.; Keljo, David J.; Leibowitz, Ian; Mamula, Petar; Pfefferkorn, Marian D.; Qureshi, Mahpara

doi:10.1097/mpg.0b013e3181919695

Cited by 61 publications

(30 citation statements)

References 25 publications

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“…In an examination of 65 adult patients with confirmed IBD, Reddy et al 12 found that there was suboptimal dosing of maintenance medications, prolonged use of corticosteroids, failure to use steroid-sparing agents, and inadequate attention to metabolic bone disease and screening for colorectal cancer. Colletti et al 13 found similar results in a study of 246 pediatric patients with CD. They noted variation in diagnostic interventions, including stool tests for pathogens, imaging of the small intestine, measurement of thiopurine methyltransferase before starting treatment with a thiopurine, and testing for tuberculosis before starting treatment with infliximab.…”

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confidence: 68%

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ImproveCareNow: The development of a pediatric inflammatory bowel disease improvement network

Crandall

Kappelman

Colletti

et al. 2011

Inflammatory Bowel Diseases

194

133

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confidence: 68%

“…With the participation of 93 pediatric gastroenterologists at 48 practice sites, the study was completed in 2008 and the findings published in 2009. 13 At the end of the 2-year grant, the cohort study had been undertaken and the design completed for the improvement network. The components of the network are described below.…”

Section: History Of Improvecarenowmentioning

confidence: 99%

ImproveCareNow: The development of a pediatric inflammatory bowel disease improvement network

Crandall

Kappelman

Colletti

et al. 2011

Inflammatory Bowel Diseases

194

133

View full text Add to dashboard Cite

show abstract

“…A multicenter pediatric study of 246 children with IBD from 48 practices who were initiating thiopurine and/or infliximab therapy demonstrated that 29% were not tested for stool pathogens at the time of initial IBD diagnosis, 30% did not receive a skin test and/or chest radiograph to screen for tuberculosis prior to infliximab initiation, and 31% of those with normal thiopurine methyltransferase (TPMT) status did not receive a starting dose of 6-mercaptopurine (6-MP) between 1 and 1.5 mg/kg/day. 8 Further evidence of a gap in IBD quality comes from a retrospective study of 67 adult IBD patients referred to a tertiary care center. Sixty-four percent were inadequately dosed with 5-aminosalicylate (5-ASA) medications, 60% receiving chronic steroids had not initiated steroid-sparing medications, and 82% of patients treated with immunomodulators received suboptimal dosages.…”

Section: Quality Of Care: Implications For Inflammatory Bowel Diseasementioning

confidence: 99%

Development of process and outcome measures for improvement: Lessons learned in a quality improvement collaborative for pediatric inflammatory bowel disease

Crandall

Boyle

Colletti

et al. 2011

Inflammatory Bowel Diseases

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The Institute of Medicine's publications, To Err is Human and Crossing the Quality Chasm, publicized the widespread deficits in healthcare quality. The quality of care in inflammatory bowel disease (IBD) has not been comprehensively evaluated, in part due to a lack of well-established IBD measures of quality. Quality can be measured for evaluation, benchmarking, or continuous quality improvement, using structural, process, and outcome measures. Measurement is an essential component of the model for improvement, necessary to determine whether changes made have resulted in improvement. Measures used for quality improvement should be based on evidence and consensus, be clear and collectable in a timely fashion, occur with sufficient frequency, and have the potential to improve outcomes. While no current IBD measures of quality are perfect, an iterative process of measure development can produce a set of measures that are feasible, relevant, and useful for performing quality improvement. This review describes the history, rationale, and methods of quality measurement and discusses the early work and lessons learned from measuring quality of care in a pediatric IBD quality improvement collaborative.

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“…Importantly, TPMT genotype is a strong predictor for TPMT activity and even patients heterozygous for the TPMT loss-of-function alleles *2A or *3 showed significantly higher incidences of dose reductions due to toxicity [67,68]. Due to the substantial body of evidence that links TPMT genotype to thiopurine treatment outcomes and adverse events, TPMT genotyping is already widely applied in clinical practice [69,70]. The costeffectiveness of preemptive TPMT genotyping remains however inconclusive [71,72] and data from randomized controlled trials is currently lacking.…”

Section: Associations Between Tpmt Genotype and Thiopurine Toxicitymentioning

confidence: 99%

Pharmacogenomic Biomarkers for Improved Drug Therapy—Recent Progress and Future Developments

Lauschke

Milani

Ingelman‐Sundberg

2017

AAPS J

120

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Abstract.Much of the inter-individual variability in drug efficacy and risk of adverse reactions is due to polymorphisms in genes encoding proteins involved in drug pharmacokinetics and pharmacodynamics or immunological responses. Pharmacogenetic research has identified a multitude of gene-drug response associations, which have resulted in genetically guided treatment and dosing decisions to yield a higher success rate of pharmacological treatment. The rapid technological developments for genetic analyses reveal that the number of genetic variants with importance for drug action is much higher than previously thought and that a true personalized prediction of drug response requires attention to millions of rare mutations. Here, we review the evolutionary background of genetic polymorphisms in drugmetabolizing enzymes, provide some important examples of current use of pharmacogenomic biomarkers, and give an update of germline and somatic genome biomarkers that are in use in drug development and clinical practice. We also discuss the current technology development with emphasis on complex genetic loci, review current initiatives for validation of pharmacogenomic biomarkers, and present scenarios for the future taking rare genetic variants into account for a true personalized genetically guided drug prescription. We conclude that pharmacogenomic information for patient stratification is of value to tailor optimized treatment regimens particularly in oncology. However, the routine use of pharmacogenomic biomarkers in clinical practice in other therapeutic areas is currently sparse and the prospects of its future implementation are being scrutinized by different international consortia.

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Variation in Care in Pediatric Crohn Disease

Abstract: There is variation in diagnostic and therapeutic interventions in the management of pediatric Crohn disease, and gaps exist between recommended and actual care.

Cited by 61 publications

References 25 publications

ImproveCareNow: The development of a pediatric inflammatory bowel disease improvement network

ImproveCareNow: The development of a pediatric inflammatory bowel disease improvement network

Development of process and outcome measures for improvement: Lessons learned in a quality improvement collaborative for pediatric inflammatory bowel disease

Pharmacogenomic Biomarkers for Improved Drug Therapy—Recent Progress and Future Developments

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