Impact of the 2008-2009 economic recession on screening colonoscopy utilization among the insured.

Background & Aims: Economic factors might affect the use of recommended preventative services. We sought to determine whether the recent severe economic recession was associated with diminished screening colonoscopy rates among an insured population and to assess the relationship between out-of-pocket (OOP) costs and screening colonoscopy use.

Methods: Administrative data from 106 health plans (IMS LifeLink Health Plan Claims Database) were analyzed to determine monthly rates of screening colonoscopies performed on beneficiaries ages 50 to 64 years between January 2005 and November 2007 (prerecession), as well as from December 2007 through June 2009 (recession).

Prevalence and epidemiology of overweight and obesity in children with inflammatory bowel disease.

Background: Obesity is a significant public health threat to children in the United States. The aims were to: 1) Determine the prevalence of obesity in a multicenter cohort of children with inflammatory bowel disease (IBD); 2) Evaluate whether overweight and obese status is associated with patient demographics or disease characteristics.

Methods: We used data from the ImproveCareNow Collaborative for pediatric IBD, a multicenter registry of children with IBD, collected between April 2007 and December 2009.

Association of paediatric inflammatory bowel disease with other immune-mediated diseases.

Background: Associations between inflammatory bowel diseases (IBDs) and other immune-mediated diseases have been described in adult populations. Whether such associations exist in childhood-onset disease remains unknown.

Objectives: The authors sought to evaluate whether paediatric IBD is associated with the occurrence of other immune-mediated diseases.

Statins are associated with reduced use of steroids in inflammatory bowel disease: a retrospective cohort study.

Background: Statin medications have antiinflammatory effects. We sought to determine whether statin use in persons with inflammatory bowel disease (IBD) was associated with reduced rates of steroid use or other markers of disease activity.

Methods: We performed a retrospective cohort study using administrative data.

Quality of care for gastrointestinal conditions: a primer for gastroenterologists.

The Institute of Medicine's publications To Err Is Human and Crossing the Quality Chasm publicized the widespread deficits in health-care quality. The quality of care for digestive diseases has not been evaluated comprehensively, although emerging literature suggests that the gap between recommended care and actual practice may be quite substantial. This paper reviews the history of, the rationale behind, and current work related to quality of care and quality improvement in the area of digestive diseases, with particular attention to colonoscopy, inflammatory bowel diseases, gastroesophageal reflux disease, chronic hepatitis C virus infection, and liver transplantation.

Development of process and outcome measures for improvement: lessons learned in a quality improvement collaborative for pediatric inflammatory bowel disease.

The Institute of Medicine's publications, To Err is Human and Crossing the Quality Chasm, publicized the widespread deficits in healthcare quality. The quality of care in inflammatory bowel disease (IBD) has not been comprehensively evaluated, in part due to a lack of well-established IBD measures of quality. Quality can be measured for evaluation, benchmarking, or continuous quality improvement, using structural, process, and outcome measures.

Thromboembolic risk among Danish children and adults with inflammatory bowel diseases: a population-based nationwide study.

Background: Recommendations for venous thromboembolism (VTE) prophylaxis in patients with inflammatory bowel disease (IBD) can be refined by incorporating patient-specific risk factors.

Objectives: To determine the risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) in children and adults with Crohn's disease and ulcerative colitis and evaluate whether this risk varies by age and/or presence of other risk factors.

Methods: We performed a cohort study using Danish administrative data.

Outcome following thiopurine use in children with ulcerative colitis: a prospective multicenter registry study.

Objectives: Despite little supporting data, thiopurine use is common in pediatric ulcerative colitis (UC). Our aim was to determine outcome following thiopurine use in a multicenter inception cohort of children diagnosed with UC.

Methods: Data were obtained from a prospective observational study of newly diagnosed children <16 years of age.

Nonmelanoma skin cancer in inflammatory bowel disease: a review.

At least 1 million new cases of nonmelanoma skin cancer (NMSC) are diagnosed in the United States each year and the incidence is increasing. A higher incidence of NMSC in organ transplant recipients on immunosuppression has been documented for some time, and recent studies indicate that patients with inflammatory bowel disease (IBD), particularly those treated with immunosuppressive medications, might also be at higher risk for this condition. In this review we summarize recent data evaluating the associations between immunomodulators, antitumor necrosis factor-α biologic agents and NMSC in patients with IBD and other autoimmune conditions such as rheumatoid arthritis.

Risk of diagnosed fractures in children with inflammatory bowel diseases.

Background: Decreased bone mass is common in children with inflammatory bowel disease (IBD); however, fracture risk is unknown. We sought to evaluate fracture risk in children with IBD as compared to unaffected controls and determine whether this risk is affected by geographical region (a proxy for sun/vitamin D exposure) and oral steroid use.

Methods: We identified cases of Crohn's disease (CD) and ulcerative colitis (UC), less than 20 years of age, using administrative data from 87 health plans.

Thiazolidinedione use and ulcerative colitis-related flares: an exploratory analysis of administrative data.

Background: Recent animal studies and clinical trials suggest that thiazolidinediones, a class of oral antidiabetic agents, are efficacious in reducing inflammation, yet no studies have evaluated their effectiveness in preventing flares. We examined the association between thiazolidinedione use and ulcerative colitis (UC)-related flares.

Methods: We conducted a retrospective cohort study using administrative data from 87 health plans across 33 states.

Short pediatric Crohn's disease activity index for quality improvement and observational research.

Background: Practical and objective instruments to assess pediatric Crohn's disease (CD) activity are required for observational research and quality improvement. The objectives were: 1) to determine the feasibility of completing the Pediatric Crohn's Disease Activity Index (PCDAI) and the Abbreviated PCDAI (APCDAI); and 2) to create a Short PCDAI by retaining and reweighting the most practical and informative components.

Methods: Physicians in the ImproveCareNow Collaborative for pediatric inflammatory bowel disease (IBD) were asked to record components of the PCDAI and assign a Physician Global Assessment (PGA) of disease severity at each patient encounter.

ImproveCareNow: The development of a pediatric inflammatory bowel disease improvement network.

Unlabelled: There is significant variation in diagnostic testing and treatment for inflammatory bowel disease. Quality improvement science methods can help address unwarranted variations in care and outcomes.

Methods: The ImproveCareNow Network was established under the sponsorship of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the American Board of Pediatrics as a prototype for a model of improving subspecialty care that included three components: 1) creating enduring multicenter collaborative networks of pediatric subspecialists, 2) sharing of performance data collected in patient registries, and 3) training in quality improvement.

Factors that determine risk for surgery in pediatric patients with Crohn's disease.

Background & Aims: We examined the incidence of Crohn's disease (CD)-related surgery in a multi-center, inception cohort of pediatric patients with CD. We also examined the effect of starting immunomodulator therapy within 30 days of diagnosis.

Methods: Data from 854 children with CD from the Pediatric Inflammatory Bowel Disease Collaborative Research Group who were diagnosed with CD between 2002 and 2008 were analyzed.

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

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.

Isotretinoin use and the risk of inflammatory bowel disease: a case-control study.

Objectives: Isotretinoin is commonly prescribed for the treatment of severe acne. Although cases of inflammatory bowel disease (IBD) have been reported in isotretinoin users, a causal association remains unproven.

Methods: We performed a case-control study using a large insurance claims database.

Increased risk for non-melanoma skin cancer in patients with inflammatory bowel disease.

Background & Aims: Patients with inflammatory bowel disease (IBD) might be at increased risk for certain malignancies. We evaluated the risk of non-melanoma skin cancer (NMSC) in patients with IBD and determined how immunosuppressive and biologic medications affect this risk.

Methods: We performed retrospective cohort and nested case-control studies by using administrative data from PharMetrics Patient Centric Database.

A causal association between isotretinoin and inflammatory bowel disease has yet to be established.

Objectives: Case reports have described a possible association between isotretinoin and inflammatory bowel disease (IBD). We critically appraised the literature on this association to assess whether it supports a causal relationship.

Methods: We systematically searched for case reports, case series, and clinical trials assessing this association.

Diagnostic ionizing radiation exposure in a population-based sample of children with inflammatory bowel diseases.

Objectives: The degree of diagnostic radiation exposure in children with inflammatory bowel diseases (IBD) is largely unknown. In this study, we describe this exposure in a population-based sample of children with IBD and determine the characteristics associated with moderate radiation exposure.

Methods: We ascertained radiological study use, demographic characteristics, IBD medication use, and the requirement for hospitalization, emergency department (ED) encounter, or inpatient gastrointestinal surgery among children with IBD within a large insurance claims database.

Quality of health care in the United States: implications for pediatric inflammatory bowel disease.

The Institute of Medicine's publications To Error is Human and Crossing the Quality Chasm publicized the widespread deficits in US health care quality. Emerging studies continue to reveal deficits in the quality of adult and pediatric care, including subspecialty care. In recent years, key stakeholders in the health care system including providers, purchasers, and the public have been applying various quality improvement methods to address these concerns.

Quality of care in inflammatory bowel disease: a review and discussion.

The Institute of Medicine's publications To Err Is Human and Crossing the Quality Chasm publicized the widespread deficits in U.S. health care quality.

Suboptimal rates of cervical testing among women with inflammatory bowel disease.

Background & Aims: Women with IBD have a high incidence of abnormal cervical cytology. However, little is known about how frequently women with IBD are tested for cervical abnormalities. We aimed to determine cervical testing rates among women with IBD, specifically those on immunosuppressant medications, and to identify risk factors associated with low incidence of screening.

Direct health care costs of Crohn's disease and ulcerative colitis in US children and adults.

Background & Aims: Data regarding the health care costs of inflammatory bowel disease (IBD) in the United States are limited. The objectives of this study were to estimate the direct costs of Crohn's disease (CD) and ulcerative colitis (UC) in the United States, describe the distribution of costs among inpatient, outpatient, and pharmaceutical services, and identify sociodemographic factors influencing these costs.

Methods: We extracted medical and pharmacy claims from an administrative database containing insurance claims from 87 health plans in 33 states, occurring between 2003 and 2004.

Nutritional concerns in pediatric inflammatory bowel disease patients.

In approximately one-fourth of patients with Crohn's disease (CD) and ulcerative colitis (UC), disease onset occurs during childhood and adolescence. In addition to gastrointestinal and extraintestinal symptoms of inflammatory bowel disease (IBD), children with these conditions often experience one or more nutritional complications of their disease including growth failure, delayed puberty, osteoporosis, anemia, and micronutrient deficiencies. This article provides an overview of the epidemiology, pathophysiology, evaluation, and management of selected nutritional complications in pediatric IBD.