title: Assessment of corticosteroid-related quality of care measures for ulcerative colitis and Crohn's disease in the United States: a claims data analysis.
abstract: To evaluate corticosteroid (CS)-related quality of care indicators in patients with ulcerative colitis (UC) and Crohn's disease (CD) in the US.
  
  
  
  Adults diagnosed with UC or CD and prescription fills for an oral CS were identified from a large commercial US claims database (2005-2013). Quality indicators included prolonged CS use (≥60 days), use of CS-sparing therapy, and bone loss assessment. State-level variations in quality of care indicators were estimated using logistic regression models adjusting for age, gender, insurance plan type, and CD severity.
  
  
  
  Of the 25,063 UC and 22,155 CD patients receiving CS, 16.1% and 12.6%, respectively, were prolonged CS users. Among prolonged CS users, 52.5% of UC and 68.2% of CD patients used CS-sparing therapy. Bone loss assessment was observed in 11.0% of UC patients with prolonged CS use and 7.7% of newly diagnosed CD patients. Prolonged CS use was the lowest in Kentucky (odds ratio [OR] = 0.59) and the highest in Wisconsin (OR = 1.41) for UC patients; the lowest in North Carolina and New York (both OR = 0.71) and the highest in Utah (OR = 2.42) for CD patients. CS-sparing therapy use was the lowest in Delaware (OR = 0.42) and the highest in Michigan (OR = 0.83) for UC patients; it was significantly different only in South Carolina (OR = 0.57) for CD patients. Bone loss assessment rates were the highest in Arizona (OR = 1.83) for UC patients and were the lowest in Mississippi (OR = 0.52) and the highest in Texas (OR = 1.51) for CD patients.
  
  
  
  Information on disease severity was not available in the database.
  
  
  
  Significant regional variations in all three quality indicators were observed across the US.
authors.affiliation: a University of Chicago Medicine, Inflammatory Bowel Disease Center , Chicago , IL , USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Rubin
authors.affiliation: b Immensity Consulting Inc. , Chicago , IL , USA.
authors.forename: Haridarshan
authors.initials: H
authors.lastname: Patel
authors.affiliation: c Analysis Group Inc. , Montreal , QC , Canada.
authors.forename: Sherry
authors.initials: S
authors.lastname: Shi
authors.affiliation: d Global Outcomes Research, Takeda Development Center Americas Inc. , Deerfield , IL , USA.
authors.forename: Reema
authors.initials: R
authors.lastname: Mody
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Corticosteroids; Crohn’s disease; quality indicators; ulcerative colitis