title: Time trends in therapies and outcomes for adult inflammatory bowel disease, Northern California, 1998-2005.
abstract: OBJECTIVE
  The management of inflammatory bowel disease (IBD) has become increasingly complicated, and it is unknown whether poor outcomes (prolonged steroid use, hospitalizations, and surgery) have declined in the general population.
  
  
  METHODS
  This multilevel study used computerized clinical data. The study comprised 2892 adults with Crohn's disease (CD) and 5895 with ulcerative colitis (UC) who received care at 16 medical centers within an integrated care organization in Northern California between 1998 and 2005.
  
  
  RESULTS
  Time trends included (1) a shift in gastroenterology-related visits from the gastroenterology division to primary care; (2) increased use of IBD-related drugs, except for a 7% decline in use of 5-aminosalicylate in CD and no change in steroid use for CD; (3) for the prevalence of prolonged steroid exposure (120 days of continuous use), a 36% decline for CD with a 27% increase for UC; (4) declines in the hospitalization rates of 33% for CD and 29% for UC; and (5) for the surgery rate, no significant change for CD with a 50% decline for UC.
  
  
  CONCLUSIONS
  Declines in prolonged steroid exposure and the hospitalization rate for CD and in the hospitalization and surgery rate for UC are encouraging; however, the increase in prolonged steroid exposure for UC merits concern and further investigation. The variability in care patterns observed in this study suggests lack of standardization of care and the opportunity to identify targets for quality improvement. These findings should stimulate research to quantify the effect of current trends in IBD management.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California 94612, USA. lisa.herrinton@kp.org
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
authors.forename: Liyan
authors.initials: L
authors.lastname: Liu
authors.forename: Bruce
authors.initials: B
authors.lastname: Fireman
authors.forename: James D
authors.initials: JD
authors.lastname: Lewis
authors.forename: James E
authors.initials: JE
authors.lastname: Allison
authors.forename: Nicole
authors.initials: N
authors.lastname: Flowers
authors.forename: Susan
authors.initials: S
authors.lastname: Hutfless
authors.forename: Fernando S
authors.initials: FS
authors.lastname: Velayos
authors.forename: Oren
authors.initials: O
authors.lastname: Abramson
authors.forename: Andrea
authors.initials: A
authors.lastname: Altschuler
authors.forename: Geraldine S
authors.initials: GS
authors.lastname: Perry
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D003424:Crohn Disease / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000639:trends; D013505:Digestive System Surgical Procedures / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents