Variation in Care of Inflammatory Bowel Diseases Patients in Crohnʼs and Colitis Foundation of America Partners

Abstract

he art of medicine allows for some expected variation in practice; however, extreme variations in care have been used as markers of poor quality of care whether secondary to insufficient evidence, lack of knowledge, misuse of health care resources, or multiple equally effective approaches.1,2 Such variation is evident in the care of both ulcerative colitis (UC) and Crohn's disease (CD) patients, although more prominent in the latter due to its heterogeneous nature.\r\rSpiegel et al2 showed that a wide variation in the everyday management of UC exists between community and expert gastroenterologists when presented with clinical vignettes. Similarly, significant variations in CD management were seen between community and expert gastroenterologists when provided with sample case vignettes,3 especially with regards to the use of 5-aminosalicylate (5-ASA) medications. However, the response of a physician to a vignette may differ greatly from their management of actual patients.\r\rDue to the variation in care evidenced in individuals with inflammatory bowel diseases (IBD), the American Gastroenterological Association developed an IBD performance measurement set with the intent of improving health outcomes through increased patient safety with an emphasis on preventive care and noncorticosteroid-based treatment options.4 The Crohn's and Colitis Foundation of America (CCFA) also sponsored the publication of a set of quality indicators (QIs) in IBD management, including treatment, surveillance, and preventive care.1 Use of such QIs establishes measurable benchmarks that can assess baseline quality of care and provide measurable standards for subsequent improvement in care.5,6