Adriana Centeno

A nationwide 2010-2012 analysis of U.S. health care utilization in inflammatory bowel diseases.

Background:Implementation of the 2010 Affordable Care Act (ACA) calls for a collaborative effort to transform the U.S. health care system toward patient-centered and value-based care. To identify how specialty care can be improved, we mapped current U.S. health care utilization in patients with inflammatory bowel diseases (IBD) using a national insurance claims database. Methods:We performed a cross-sectional study analyzing U.S. health care utilization in 964,633 patients with IBD between 2010 and 2012 using insurance claims data, including pharmacy and medical claims. Frequency of IBD-related care utilization (medication, tests, and treatments) and their charges were evaluated. Subsequently, outcomes were put into the framework of current U.S. guidelines to identify areas of improvement. Results:A disproportionate usage of aminosalicylates in Crohns disease (42%), frequent corticosteroid use (46%, with 9% long-term users), and low rates of corticosteroid-sparing drugs (thiopurines 15%; methotrexate 2.7%) were observed. Markers for inflammatory activity, such as C-reactive protein or fecal calprotectin were not commonly used (8.8% and 0.13%, respectively). Although infrequently used (11%), anti-TNF antibody therapy represents a major part of observed IBD charges. Conclusions:This analysis shows 2010–2012 utilization and medication patterns of IBD health care in the United States and suggests that improvement can be obtained through enhanced guidelines adherence.

The impact of value-based healthcare for inflammatory bowel diseases on healthcare utilization: a pilot study.

Background and objectives Value-based healthcare (VBHC) is considered to be the solution that will improve quality and decrease costs in healthcare. Many hospitals are implementing programs on the basis of this strategy, but rigorous scientific reports are still lacking. In this pilot study, we present the first-year outcomes of a VBHC program for inflammatory bowel disease (IBD) management that focuses on highly coordinated care, task differentiation of providers, and continuous home monitoring. Methods IBD patients treated within the VBHC program were identified in an administrative claims database from a commercial insurer allowing comparisons to matched controls. Only patients for whom data were available the year before and after starting the program were included. Healthcare utilization including visits, hospitalizations, laboratory and imaging tests, and medications were compared between groups. Results In total, 60 IBD patients treated at the VBHC Center were identified and were matched to 177 controls. Significantly fewer upper endoscopies were performed (−10%, P=0.012), and numerically fewer surgeries (−25%, P=0.49), hospitalizations (−28%, 0=0.71), emergency department visits (-37%, P=0.44), and imaging studies (−25 to −86%) were observed. In addition, 65% fewer patients (P=0.16) used steroids long term. IBD-related costs were 16% (

Presenteeism in Inflammatory Bowel Diseases: A Hidden Problem with Significant Economic Impact

771) lower than expected (P=0.24). Conclusion These are the first results of a successfully implemented VBHC program for IBD. Encouraging trends toward fewer emergency department visits, hospitalizations, and long-term corticosteroid use were observed. These results will need to be confirmed in a larger sample with more follow-up.

Tu1075 The Impact of a Value-Based Health Program for Inflammatory Bowel Disease Management on Healthcare Utilization

Background:Indirect costs associated with impaired productivity at work (presenteeism) due to inflammatory bowel disease (IBD) are a major contributor to health expenditures. Studies estimating indirect costs in the United States did not take presenteeism into account. We aimed to quantify work limitations and presenteeism and its associated costs in an IBD population to generate recommendations to reduce presenteeism and decrease indirect costs. Methods:We performed a prospective study at a tertiary IBD center. During clinic visits, work productivity, work-related problems and adjustments, quality of life, and disease activity were assessed in patients with IBD. Work productivity and impairment were assessed in a control population as well. Indirect costs associated with lost work hours (absenteeism) and presenteeism were estimated, as well as the effect of disease activity on those costs. Results:Of the 440 included patients with IBD, 35.6% were unemployed. Significantly more presenteeism was detected in patients with IBD (62.9%) compared with controls (27.3%) (P = 0.004), with no significant differences in absenteeism. Patients in remission experienced significantly more presenteeism than controls (54.7% versus 27.3%, respectively, P < 0.01), and indirect costs were significantly higher for remissive patients versus controls (

Su1105 The Development and Evaluation of Coordinated Care Pathways for Inflammatory Bowel Diseases

17,766 per yr versus

308 The Impact of a Value-Based Health Care in Inflammatory Bowel Diseases on Health Care Utilization

9179 per yr, respectively, P < 0.03). Only 34.3% had made adjustments to battle work-related problems such as fatigue, irritability, and decreased motivation. Conclusions:Patients with IBD in clinical remission still cope with significantly more presenteeism and work limitations than controls; this translates in higher indirect costs and decreased quality of life. The majority have not made any adjustments to battle these problems.

311a Assessment of Differences Between Academic and Non-Academic Providers in Inflammatory Bowel Diseases Related Utilization Using a Large Administrative Dataset

is cardiovascular disease for which antiplatelets and anticoagulants are prescribed. Thus, baby boomers are at risk of gastrointestinal bleeding (GIB) related to both pharmacologic exposure and advancing age. In 2012, the cost of GIB care was estimated at >

Tu1231 Time-Driven Activity Based Costing: Measuring the Costs of Implementing Quality Measures in Inflammatory Bowel Disease (IBD)

2.5 billion; half of which was billed to Medicare. Quantifying health care utilization of current baby boomers with GI bleeding will assist policy makers to forecast impact of this generation on future health care resource needs. Methods: A retrospective cohort study using 5 years of the Nationwide Inpatient Sample (2007-2011) was conducted to identify temporal trends in non-variceal, upperand lower-GIB to assess impact of age, co-morbidity, early vs. late endoscopy, transfer status, and disposition on the outcomes of hospital length of stay, 30day mortality and economic outcomes (charge). Temporal trends were evaluated using the Cochrane-Armitage test. The Chi-square test and multivariable linear regression models were used to quantify the impact of exposures of interest and potential effect modifiers on hospital length of stay and charge. Results: From 2007 to 2011 there were 1,322,122 hospital visits associated with GIB in 18,259,654 patients >50 years. Three-quarters of admissions were emergent, 19% occurred on the weekend and 51% were lower GIB. Overall prevalence was 7.2%, with an average length of stay (LOS) of 5.5 days (SD: 6.1) in 2007 that decreased to 5.1 days (SD: 5.7) by 2011 (p<0.001). A 1.4 day (95% CI: 1.31-1.44) increase in LOS was observed among patients ≥70 with a Charlson co-morbidity score ≥2. In-hospital mortality decreased over time from 2.5% to 2.0% (p<0.001). Total hospital charge increased over time from

DOP089 Measurement of IBD disease activity using home-based e-health technologies

29,602 (2007) to

DOP026 Work related problems and impaired productivity in patients with inflammatory bowel diseases (IBD)

38,549 (2011), p<0.001. Medicare or Medicaid was the primary payer in 39%. Primary drivers of the attributable charge (per admission) included age ≥70 years with a Charlson co-morbidity score ≥2 (