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Utilization of healthcare resources by U.S. children and adults with inflammatory bowel disease

Kappelman, Michael D. MD, MPH1; Porter, Carol Q. BS1; Galanko, Joseph A. PhD1; Rifas‐Shiman, Sheryl L. MPH2; Ollendorf, Daniel A. MPH3; Sandler, Robert S. MD, MPH1; Finkelstein, Jonathan A. MD, MPH2,4

doi: 10.1002/ibd.21371
Original Clinical Articles

Background:: The inflammatory bowel diseases (IBDs) Crohn's disease (CD) and ulcerative colitis (UC) affect over 1 million people in the United States, yet little is known about healthcare utilization by affected individuals. The objectives were to describe the healthcare utilization associated with IBD in an insured U.S. population and to determine how sociodemographic factors impact healthcare utilization in this population.

Methods:: Using an administrative database comprised of 87 health plans, we ascertained cases of CD and UC using an administrative definition. We identified inpatient, office‐based, emergency (ED), and endoscopy services occurring between 2003–2004 in IBD patients and matched controls. For each case, excess utilization was determined by subtracting the mean number of control visits from the number of case visits. Multivariate logistic and linear regressions were used to identify the sociodemographic factors associated with excess utilization.

Results:: We identified 9056 CD patients and 10,364 UC patients. The mean number of annual excess hospitalizations, ED visits, and office visits per 100 patients for CD were 21.7, 20.1, and 493, respectively. These values for UC were 13.3, 10.3, and 364, respectively. In general, utilization was higher in CD compared with UC, and in younger patients compared with older patients. Utilization also varied by gender, geographical region, and insurance type (Medicaid versus commercial).

Conclusions:: In the U.S., patients with IBD consume substantial healthcare resources. Resource utilization varies by patient age and disease type, and to a lesser extent, gender, geographical region, and insurance type. These findings may be used to inform health policy. (Inflamm Bowel Dis 2011;)

1University of North Carolina Chapel Hill, Chapel Hill, North Carolina

2Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts

3Institute for Clinical and Economic Review, Boston, Massachusetts

4Division of General Pediatrics, Children's Hospital Boston, Boston, Massachusetts

Reprints: University of North Carolina Chapel Hill, Department of Pediatrics, Division of Pediatric Gastroenterology, 130 Mason Farm Road, campus box 7229, Chapel Hill, NC 27599

Email: michael_kappelman@med.unc.edu

Received 23 March 2010; Accepted 28 April 2010

Grant sponsor: National Center for Research Resources (NCRR) grant; Grant Number: KL2 RR025746; Grant sponsor: National Institute for Diabetes and Digestive and Kidney Diseases grant; Grant Number: P30 DK034987.

© Crohn's & Colitis Foundation of America, Inc.
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