Analysis of an Administrative Claims Database Suggests Poor Quality of Care for Inflammatory Bowel Disease

Abstract

Introduction: Inflammatory bowel disease (IBD) is a chronic condition that significantly impacts quality of life. In 2012 the American Gastroenterological Association (AGA) publicized 10 clinical performance measures to establish evidence-based standards of quality care for patients with IBD. Methods: We assessed the AGA IBD measures using claims captured in the OptumInsight administrative claims database. Patients ≥18 years of age with Crohn’s disease or ulcerative colitis were identified using international classification of diseases (ICD)-9 codes and were followed for 1 year after first IBD diagnosis in 2010, 2011, or 2012. The AGA IBD physician performance measures include assessment of type, anatomic location, and activity of IBD; use of corticosteroid-sparing therapy; bone loss assessment in patients at risk of corticosteroid-related iatrogenic injury; influenza and pneumococcal immunizations; testing for tuberculosis and hepatitis B virus before starting anti-tumor necrosis factor (TNF) therapy and for C. difficile during a hospital stay; prophylaxis for venous thromboembolism; and screening/cessation intervention for tobacco users. The percent of patients meeting AGA criteria for each measure was calculated by dividing the number of patients meeting criteria by the number of patients eligible to meet criteria. Inclusion of patients in the calculations was determined using ICD-9 and current procedural terminology (CPT) codes specified for each measure.Table 1: AGA IBD physician performance measuresResults: Among IBD patients, the percent of patients meeting AGA criteria ranged from 2.7% for tobacco user screening/cessation intervention to 69.2% for use of corticosteroid-sparing therapy (Table). Adherence was less than 30% for 8 of 10 quality measures. Conclusion: The quality of IBD care as assessed by administrative claims is poor. Future work needs to (a) compare the quality of care after 2012 to determine any changes in adherence following publication of the measures (b) examine whether current AGA measures capture all aspects of quality care and (c) explore alternative data sources that better capture provider recommendations to patients. Disclosure - GY Melmed: Consultant/advisory board: AbbVie, Jannsen, UCB, Given Imaging, Luitpold Pharmaceuticals, Celgene; Research Support: Pfizer, Shire, Prometheus Labs. AB Ozbay, M Skup, S Wang, J Chao: Employee + Stockholder - AbbVie. CA Siegel: Consultant/Advisory Board: Abbvie, BiolineRX, Given Imaging, Lilly, Janssen, Salix, Millenium, Pfizer, Prometheus, Takeda, UCB; Speaker for CME activities: Abbvie, Janssen, Merck.