title: A nationwide 2010-2012 analysis of U.S. health care utilization in inflammatory bowel diseases.
abstract: 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 Crohn's 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.
authors.affiliation: *UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; †Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands; ‡Qforma Inc., Santa Fe, New Mexico; and §Department of Surgery, and ‖Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Welmoed K
authors.initials: WK
authors.lastname: van Deen
authors.forename: Martijn G H
authors.initials: MG
authors.lastname: van Oijen
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Myers
authors.forename: Adriana
authors.initials: A
authors.lastname: Centeno
authors.forename: William
authors.initials: W
authors.lastname: Howard
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Choi
authors.forename: Bennett E
authors.initials: BE
authors.lastname: Roth
authors.forename: Erin M
authors.initials: EM
authors.lastname: McLaughlin
authors.forename: Daniel
authors.initials: D
authors.lastname: Hollander
authors.forename: Belinda
authors.initials: B
authors.lastname: Wong-Swanson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sack
authors.forename: Michael K
authors.initials: MK
authors.lastname: Ong
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Ha
authors.forename: Eric
authors.initials: E
authors.lastname: Esrailian
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Hommes
mesh_terms: D003093:Colitis, Ulcerative / Q000517:prevention & control*; D003424:Crohn Disease / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D055118:Medication Adherence; D009313:National Health Programs; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors