: There is little understanding of the consistency and quality of treatment given to inflammatory bowel disease (IBD) patients in the community setting. Practice guidelines have been published, but it is unknown whether they are appropriate for and adhered to in community practice, or whether there are barriers to their implementation. We hypothesize relatively high variation in drug therapy for maintenance of remission in Crohn's disease (CD) and ulcerative colitis (DC). If variation is high for reasons that cannot be justified, then there may be opportunities to improve care by changing the forces that drive treatment decision-making. The study will describe the natural history of CD and DC, and whether care is consistent with practice guidelines. It will assess predictors of therapies, visits, and procedures, including predictors at the level of the patient, the disease, the provider, and the clinic. If possible, we will also link predictors and therapies to flare. Patient and disease characteristics will include: (a) the type and severity of IBD, (b) age and demographics, and (c) co-morbidity. Provider characteristics will include (a) specialty, (b) gender and years of experience, (c) IBD patient volume, and (d) actual average use of the procedures and therapies across their IBD patient panel. Therapies will include: (a) 5ASA medications for maintenance of remission in UC, (b) 6MP/azathioprine for maintenance of remission in patients in CD and UC, (c) steroids, both short- and long-term, (d) infliximab, and (e) patient adherence to medications. Outcomes will include: (a) utilization of visits, procedures, and drugs, and (b) disease flare. In addition, we will qualitatively assess organizational factors, operating at the level of the clinic, that affect therapy decision-making, including staffing, information, guidelines, peer review, and specialist expertise, among others. The study will be conducted at Kaiser Permanente, Northern California. It will include more than 7,000 IBD patients who were enrolled for at least one year as of January 1, 2001 as well 75 gastroenterologists and primary care providers working at 20 clinics across Northern California. Patients will be observed from 1995 through 2006, with predictors being assessed during the first half of the 12-year observation period (1995-2000), utilization during the second half (2001-2006), and drug therapy and disease activity throughout the entire 12-year period. Provider information will be obtained from the computerized provider file with IBD patient volume and actual average drug use in their IBD patient panel determined from utilization data. All analyses will be conducted separately for CD and UC. Analytical models that take into account the non independence of patients within providers and clinics will be used to simultaneously evaluate all key variables ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Center for Chronic Disease Prev and Health Promo (NCCDPHP)
Type
Research Project--Cooperative Agreements (U01)
Project #
1U01DP000340-01
Application #
7124046
Study Section
Special Emphasis Panel (ZDP1-FXR (IB))
Program Officer
Patterson, Beth
Project Start
2005-09-30
Project End
2010-09-29
Budget Start
2005-09-30
Budget End
2006-09-29
Support Year
1
Fiscal Year
2005
Total Cost
$692,682
Indirect Cost
Name
Crohn's and Colitis Fdn of America, Inc.
Department
Type
DUNS #
075255455
City
New York
State
NY
Country
United States
Zip Code
10016
Grand, David J; Harris, Adam; Shapiro, Jason et al. (2016) Risk factors for radiation exposure in newly diagnosed IBD patients. Abdom Radiol (NY) 41:1363-9
Townsend, Peter; Zhang, Qibin; Shapiro, Jason et al. (2015) Serum Proteome Profiles in Stricturing Crohn's Disease: A Pilot Study. Inflamm Bowel Dis 21:1935-41
Saha, Sumona; Zhao, Ying-Qi; Shah, Samir A et al. (2015) Body image dissatisfaction in patients with inflammatory bowel disease. Inflamm Bowel Dis 21:345-52
Krishnarao, Anita; de Leon, Lauren; Bright, Renee et al. (2015) Testing for Clostridium difficile in patients newly diagnosed with inflammatory bowel disease in a community setting. Inflamm Bowel Dis 21:564-9
Cohen, B L; Zoëga, H; Shah, S A et al. (2014) Fatigue is highly associated with poor health-related quality of life, disability and depression in newly-diagnosed patients with inflammatory bowel disease, independent of disease activity. Aliment Pharmacol Ther 39:811-22
Saha, Sumona; Zhao, Ying-Qi; Shah, Samir A et al. (2014) Menstrual cycle changes in women with inflammatory bowel disease: a study from the ocean state Crohn's and colitis area registry. Inflamm Bowel Dis 20:534-40
Saha, Sumona; Lam, Manuel; Roberson, Erica et al. (2012) Evaluation of possible inflammatory bowel disease: a survey of Rhode Island physicians. Med Health R I 95:4-8
Velayos, Fernando S; Liu, Liyan; Lewis, James D et al. (2010) Prevalence of colorectal cancer surveillance for ulcerative colitis in an integrated health care delivery system. Gastroenterology 139:1511-8
Lam, Manuel Y; Lee, Hang; Bright, Renee et al. (2009) Validation of interactive voice response system administration of the Short Inflammatory Bowel Disease Questionnaire. Inflamm Bowel Dis 15:599-607
Lewis, James D; Abramson, Oren; Pascua, Monina et al. (2009) Timing of myelosuppression during thiopurine therapy for inflammatory bowel disease: implications for monitoring recommendations. Clin Gastroenterol Hepatol 7:1195-201; quiz 1141-2

Showing the most recent 10 out of 11 publications