scholarly journals Public versus Private Drug Insurance and Outcomes of Patients Requiring Biologic Therapies for Inflammatory Bowel Disease

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Amir Rumman ◽  
Roberto Candia ◽  
Justina J. Sam ◽  
Kenneth Croitoru ◽  
Mark S. Silverberg ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Emergency Department Visits ◽  
Drug Coverage ◽  
Timely Access ◽  
Inflammatory Bowel ◽  
Ed Visits ◽  
Insured Patients ◽  
Public Drug ◽  
Privately Insured

Background. Antitumor necrosis factor (anti-TNF) therapy is a highly effective but costly treatment for inflammatory bowel disease (IBD).Methods. We conducted a retrospective cohort study of IBD patients who were prescribed anti-TNF therapy (2007–2014) in Ontario. We assessed if the insurance type was a predictor of timely access to anti-TNF therapy and nonroutine health utilization (emergency department visits and hospitalizations).Results. There were 268 patients with IBD who were prescribed anti-TNF therapy. Public drug coverage was associated with longer median wait times to first dose than private one (56 versus 35 days,P=0.002). After adjusting for confounders, publicly insured patients were less likely to receive timely access to anti-TNF therapy compared with those privately insured (adjusted hazard ratio, 0.66; 95% CI: 0.45–0.95). After adjustment for demographic and clinical characteristics, publicly funded subjects were more than 2-fold more likely to require hospitalization (incidence rate ratio [IRR], 2.30; 95% CI: 1.19–4.43) and ED visits (IRR 2.42; 95% CI: 1.44–4.08) related to IBD.Conclusions. IBD patients in Ontario with public drug coverage experienced greater delays in access to anti-TNF therapy than privately insured patients and have a higher rate of hospitalizations and ED visits related to IBD.

scholarly journals Predicting 30-Day Readmission Rate in Inflammatory Bowel Disease Patients: Performance of LACE Index

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Lauren A George ◽  
Brendan Martin ◽  
Neil Gupta ◽  
Nikhil Shastri ◽  
Mukund Venu ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Length Of Stay ◽  
Bowel Disease ◽  
Readmission Rate ◽  
Risk Group ◽  
Tertiary Care ◽  
Emergency Department Visits ◽  
Unplanned Readmission ◽  
Significant Difference ◽  
Inflammatory Bowel

AbstractBackground and AimsReadmission within 30 days in inflammatory bowel disease (IBD) patients increases treatment costs and serves as a quality indicator. The LACE (Length of stay, Acuity of admission, Charlson comorbidity index, Emergency Department visits in past 6 months) index is used to predict the risk of unplanned readmission within 30 days. The aim of this study was to evaluate the accuracy of using the LACE index in IBD.MethodsCalculation of LACE index was done prospectively for IBD patients admitted to a single tertiary care center. Patient, disease, and treatment characteristics, as well as index hospitalization characteristics including indication for admission and disease activity measures were retrospectively recorded. Descriptive statistics and univariable exact logistic regression analyses were performed.ResultsIn total, 64 IBD patients were admitted during the study period. The 30-day readmission rate of IBD patients was 19% and overall median LACE index was 6, with IQR 6–7. LACE index categorized 16% of IBD patients in low-risk group, 82% in moderate risk group, and 2% in high-risk group. LACE index did not predict 30-day readmission (OR 1.35, CI: 0.88–2.18, P = 0.19). There was no significant difference in 30-day readmission rates with inpatient antibiotic or narcotic use, admission C-reactive protein (CRP), anemia, IBD duration, maintenance therapy, or prior IBD operation. For every 1 day increase in length of stay (LOS), patients were 8% more likely (OR: 1.08, 95% CI: 1.00–1.16) to be readmitted within 30 days (P = .05).ConclusionsLACE index does not accurately identify 30-day readmission risk in the IBD population. As increased LOS is associated with higher risk, there may be benefit for targeted strategic resource allocation via specialized services.

scholarly journals Mental Health Costs of Inflammatory Bowel Diseases

2020 ◽  
Vol 27 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Eva Szigethy ◽  
Sean M Murphy ◽  
Orna G Ehrlich ◽  
Nicole M Engel-Nitz ◽  
Caren A Heller ◽  
...  
Keyword(s):  
Mental Health ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Claims Data ◽  
The United States ◽  
Cost Of Care ◽  
Medical Utilization ◽  
Administrative Claims ◽  
Inflammatory Bowel ◽  
Ed Visits

Abstract Background Mental health diagnoses (MHDs) were identified as significant drivers of inflammatory bowel disease (IBD)-related costs in an analysis titled “Cost of Care Initiative” supported by the Crohn’s & Colitis Foundation. In this subanalysis, we sought to characterize and compare IBD patients with and without MHDs based on insurance claims data in terms of demographic traits, medical utilization, and annualized costs of care. Methods We analyzed the Optum Research Database of administrative claims from years 2007 to 2016 representing commercially insured and Medicare Advantage insured IBD patients in the United States. Inflammatory bowel disease patients with and without an MHD were compared in terms of demographics (age, gender, race), insurance type, IBD-related medical utilization (ambulatory visits, emergency department [ED] visits, and inpatient hospitalizations), and total IBD-related costs. Only patients with costs >$0 in each of the utilization categories were included in the cost estimates. Results Of the total IBD study cohort of 52,782 patients representing 179,314 person-years of data, 22,483 (42.6%) patients had at least 1 MHD coded in their claims data with a total of 46,510 person-years in which a patient had a coded MHD. The most commonly coded diagnostic categories were depressive disorders, anxiety disorders, adjustment disorders, substance use disorders, and bipolar and related disorders. Compared with patients without an MHD, a significantly greater percentage of IBD patients with MHDs were female (61.59% vs 48.63%), older than 75 years of age (9.59% vs 6.32%), white (73.80% vs 70.17%), and significantly less likely to be younger than 25 years of age (9.18% vs 11.39%) compared with those without mental illness (P < 0.001). Patients with MHDs had significantly more ED visits (14.34% vs 7.62%, P < 0.001) and inpatient stays (19.65% vs 8.63%, P < 0.001) compared with those without an MHD. Concomitantly, patients with MHDs had significantly higher ED costs ($970 vs $754, P < 0.001) and inpatient costs ($39,205 vs $29,550, P < 0.001) compared with IBD patients without MHDs. Patients with MHDs also had significantly higher total annual IBD-related surgical costs ($55,693 vs $40,486, P < 0.001) and nonsurgical costs (medical and pharmacy) ($17,220 vs $11,073, P < 0.001), and paid a larger portion of the total out-of-pocket cost for IBD services ($1017 vs $905, P < 0.001). Conclusion Patients whose claims data contained both IBD-related and MHD-related diagnoses generated significantly higher costs compared with IBD patients without an MHD diagnosis. Based on these data, we speculate that health care costs might be reduced and the course of patients IBD might be improved if the IBD-treating provider recognized this link and implemented effective behavioral health screening and intervention as soon as an MHD was suspected during management of IBD patients. Studies investigating best screening and intervention strategies for MHDs are needed.

scholarly journals A65 VARIATION IN THE CARE OF CHILDREN WITH INFLAMMATORY BOWEL DISEASE: A CANGIEC POPULATION-BASED STUDY

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 78-79
Author(s):  
E Kuenzig ◽  
H Singh ◽  
A Bitton ◽  
G G Kaplan ◽  
M W Carroll ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Quality Care ◽  
Intestinal Resection ◽  
Specialist Care ◽  
High Quality ◽  
Inflammatory Bowel ◽  
Ed Visits ◽  
Incident Cases ◽  
Pediatric Ibd

Abstract Background Inflammatory bowel disease (IBD) is rising rapidly in Canadian children. These children require consistent high-quality specialized care to prevent long-term complications. Aims Evaluate variation in health services utilization and surgery rates across pediatric IBD centres in Ontario. Methods Incident cases of IBD <16y (1999–2010), identified from health administrative data using a validated algorithm, were assigned to pediatric IBD centres based on location of IBD hospitalization, endoscopy and outpatient care. Children receiving IBD-specific care outside pediatric centres were also grouped. Frailty models, median hazard ratios (MHR), and Kendall’s t described variation in IBD-related ED visits, hospitalizations, and surgery 6–60 months after diagnosis, adjusting for age, sex, rural/urban household, and income. Mean diagnostic lag (time from first health system contact for an IBD symptom to final IBD diagnosis) and proportion of children with IBD care by gastroenterologists (GIs) at each centre were evaluated as centre-level predictors of variation. Results Of 2584 IBD cases, 73.4% were treated in a pediatric IBD centre. Between-centre differences accounted for 0.18% (MHR 1.06) and 0.41% (MHR 1.09) of variation in hospitalizations and ED visits, respectively. Children treated at centres where a higher proportion of children were cared for by GIs were more likely to be hospitalized (HR 2.09, 95% CI 1.26–3.45). Children treated at centres with a longer mean diagnostic lag were also more likely to be hospitalized (HR 1.01, 95% CI 1.003–1.02). ED visits were not associated with the proportion of children cared for by gastroenterologists or diagnostic lag. Among 1529 CD cases, 14.1% required intestinal resection; 1.79% of variation in the risk of surgery resulted from between-centre differences (MHR 1.20). Surgery was less common among patients at centres where more children were cared for by GIs (HR 0.24, 95% CI 0.07–0.84) and with a longer mean diagnostic lag (HR 0.98, 95% CI 0.97–0.99). After adjusting for these, between-centre differences accounted for 0.005% (MHR 1.01) of variation in care. Minimal variation was observed among the 11.0% of 872 UC cases requiring colectomy, with 0.37% of variation due to between-centre differences (MOR 1.09). Colectomy risk was not associated with GI care or diagnostic lag. Conclusions Variation in ED visits, hospitalizations, and surgery among children with IBD is small; however, centre-level differences in GI specialist care use and time to diagnosis were associated with hospitalization and surgery. It is essential to understand between-centre differences to reduce variation and ensure high-quality care. Funding Agencies CCC

scholarly journals Increased Healthcare Utilization by Patients With Inflammatory Bowel Disease Covered by Medicaid at a Tertiary Care Center

2019 ◽  
Vol 25 (10) ◽  
pp. 1711-1717 ◽  
Author(s):  
Jordan E Axelrad ◽  
Rajani Sharma ◽  
Monika Laszkowska ◽  
Christopher Packey ◽  
Richard Rosenberg ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Socioeconomic Status ◽  
Low Socioeconomic Status ◽  
Bowel Disease ◽  
Insurance Status ◽  
Low Socioeconomic ◽  
Inpatient Hospitalizations ◽  
Inflammatory Bowel ◽  
Ed Visits ◽  
The Impact

Abstract Background Low socioeconomic status has been linked with numerous poor health outcomes, but data are limited regarding the impact of insurance status on inflammatory bowel disease (IBD) outcomes. We aimed to characterize utilization of healthcare resources by IBD patients based on health insurance status, using Medicaid enrollment as a proxy for low socioeconomic status. Methods We retrospectively identified adult patients with IBD engaged in a colorectal cancer surveillance colonoscopy program from July 2007 to June 2017. Our primary outcomes included emergency department (ED) visits, inpatient hospitalizations, biologic infusions, and steroid exposure, stratified by insurance status. We compared patients who had ever been enrolled in Medicaid with all other patients. Results Of 947 patients with IBD, 221 (23%) had been enrolled in Medicaid. Compared with patients with other insurance types, patients with Medicaid had higher rates of ever being admitted to the hospital (77.6% vs 42.6%, P < 0.0001) or visiting the ED (90.5% vs 38.4%, P < 0.0001). When adjusted for sex, age at first colonoscopy, and ethnicity, patients with Medicaid had a higher rate of inpatient hospitalizations (Rate ratio [RR] 2.95; 95% CI 2.59–3.36) and ED visits (RR 4.24; 95% CI 3.82–4.70) compared to patients with other insurance. Patients with Medicaid had significantly higher prevalence of requiring steroids (62.4% vs 37.7%, P < 0.0001), and after adjusting for the same factors, the odds of requiring steroids in the patients with Medicaid was increased (OR 3.77; 95% CI 2.53–5.62). Conclusions Medicaid insurance was a significant predictor of IBD care and outcomes. Patients with Medicaid may have less engagement in IBD care and seek emergency care more often.

Sign in / Sign up

Export Citation Format

Share Document