title: The high frequency of healthcare use in patients one year prior to a sarcoidosis diagnosis.
abstract: BACKGROUND
  The clinical presentation of sarcoidosis can be varied. Prior investigations have shown that diagnosis is often delayed over six months, particularly in patients with pulmonary symptoms. Delays may lead to high healthcare use prior to diagnosis.
  
  
  OBJECTIVE
  To investigate healthcare use prior to diagnosis of sarcoidosis for a cohort of insured patients.
  
  
  METHODS
  We conducted a case-control study using a de-identified limited dataset of private health insurance claims.  Cases were identified as persons with sarcoidosis from 2003-2009. Controls with other respiratory-related diagnoses (asthma, chronic obstructive pulmonary disease, pneumonia) were matched by age, gender, and diagnosis date. We compared frequencies of doctor visits, prescriptions, and imaging in the year prior to established diagnosis.
  
  
  RESULTS
  We identified 206 cases and 2060 controls and compared healthcare use patterns in the year prior to diagnosis. Among those receiving prescriptions, a larger proportion of cases received two or more antibiotic courses (69% vs. 55%, p=0.0020) or two or more corticosteroid prescriptions (63% vs. 50%, p=0.0137). On average, cases had more doctor visits (14.7 vs. 7.8, p&lt;0.0001), saw more specialties (3.9 vs. 2.1, p&lt;0.0001), and underwent more chest x-rays (2.0 vs. 1.5, p&lt;0.0001). A larger proportion of cases underwent two or more chest x-rays (54% vs. 24%, p&lt;0.0001).
  
  
  CONCLUSIONS
  Patients with sarcoidosis undergo a large amount of healthcare prior to diagnosis, some of which may not be necessary, compared to controls with respiratory-related disease. These results highlight the need for improved diagnostic algorithms to identify patients with sarcoidosis and avoid potentially excessive delays in diagnosis.
authors.affiliation: Department of Internal Medicine: Pulmonary and Critical Care University of Iowa Hospitals and Clinics Iowa City, IA - 52242. alicia-gerke@uiowa.edu.
authors.forename: Alicia K
authors.initials: AK
authors.lastname: Gerke
authors.forename: Fan
authors.initials: F
authors.lastname: Tang
authors.forename: Jane
authors.initials: J
authors.lastname: Pendergast
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Cavanaugh
authors.forename: Philip M
authors.initials: PM
authors.lastname: Polgreen
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016208:Databases, Factual; D057210:Delayed Diagnosis; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D011307:Drug Prescriptions; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D007484:Iowa; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D017149:Private Sector; D011859:Radiography; D012189:Retrospective Studies; D017565:Sarcoidosis, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D013997:Time Factors; D019564:Unnecessary Procedures; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents