Variation in Treatment of Patients With Inflammatory Bowel Diseases at Major Referral Centers in the United States

Ashwin N. Ananthakrishnan, Jennifer Kwon, Laura Raffals, Bruce Sands, William F. Stenson, Dermot McGovern, John H. Kwon, Robert L. Rheaume, Robert S. Sandler

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


We performed a prospective study of patients with inflammatory bowel diseases to examine variations in treatment among medical centers. In a prospective cohort study of 1659 patients with Crohn's disease and 946 patients with ulcerative colitis seen at 7 high-volume referral centers, we collected data on demographics, disease characteristics, and medical and surgical treatments. We used logistic regression to determine differences in treatment among centers, controlling for potential confounders. We found significant variations among centers in the treatment of Crohn's disease with immunomodulators (odds ratio [OR], 3.34; 95% confidence interval [CI], 2.09-5.32) but not anti-tumor necrosis factor agents (OR, 1.64; 95% CI, 0.97-2.77). There was less variation in the treatment of ulcerative colitis; we found no difference in use of immunomodulators (OR, 1.83; 95% CI, 1.00-3.36) or anti-tumor necrosis factor therapy (OR, 0.81; 95% CI, 0.40-1.65). The development and implementation of evidence-based standards of care for inflammatory bowel disease may help reduce variation and improve outcomes.

Original languageEnglish (US)
Pages (from-to)1197-1200
Number of pages4
JournalClinical Gastroenterology and Hepatology
Issue number6
StatePublished - Jun 1 2015


  • Anti-TNF Agent
  • IBD
  • Practice Variation
  • Sinai Helmsley Alliance for Research Excellence (SHARE) Consortium

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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