Delays Related to Prior Authorization in Inflammatory Bowel Disease.
Delays Related to Prior Authorization in Inflammatory Bowel Disease.
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DOI：
10.1542/peds.2021-052501
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发表时间：
2022-03-01
期刊：
影响因子：
8
通讯作者：
Scott FI
中科院分区：
文献类型：
--
作者：
Constant BD;de Zoeten EF;Stahl MG;Vajravelu RK;Lewis JD;Fennimore B;Gerich ME;Scott FI
生物疗法进展的延迟与炎症性肠病（IBD）的不良结局相关。保险公司要求的事先授权与延长的药物起始时间有关。我们假设先前的批准与IBD儿童生物起始时间延长和IBD相关医疗保健利用增加有关。我们对一家三级医院的190名IBD患儿进行了回顾性队列研究，以衡量事先批准、生物起始时间（医生推荐首次给药）和医疗保健利用（住院、手术或急诊）之间的关系。收集了人口统计、保险和疾病严重程度相关的协变量。采用多变量线性回归测量预先授权与生物起始时间之间的关系。倾向评分方法用于测量180天内ibd相关医疗保健利用和90天内皮质类固醇依赖之间的关联，并对保险类型、人口统计学和疾病严重程度相关特征进行调整。中位生物起始时间为21天。先前授权和复杂的先前授权（要求上诉、分步治疗或同行评审）分别与10.2天（95%可信区间[CI] 8.2至12.3）和24.6天（95% CI 16.4至32.8）的生物起始时间增加相关。先前的批准使180天内ibd相关医疗保健利用的可能性增加了12.9% (95% CI 2.5 - 23.4)， 90天内皮质类固醇依赖的可能性增加了14.1% （95% CI 3.3 - 24.8）。先前的批准与延长的生物起始时间和增加的ibd相关医疗保健利用率相关。最大限度地减少与事先授权相关的延迟可以加快生物交付并降低ibd相关医疗保健利用的风险。
Delays in advancing to biologic therapies are associated with adverse outcomes in inflammatory bowel disease (IBD). Insurer-mandated prior authorizations have been linked to prolonged medication initiation times. We hypothesized that prior authorizations are associated with prolonged biologic initiation time and increased IBD-related healthcare utilization among children with IBD. We performed a retrospective cohort study of 190 pediatric patients with IBD initiating biologics at a tertiary care hospital to measure the association between prior authorization, biologic initiation time (physician recommendation to first dose), and healthcare utilization (hospitalization, surgery, or emergency department visit). Demographic, insurance, and disease severity–related covariables were collected. Multivariable linear regression was used to measure the association between prior authorization and biologic initiation time. Propensity score methods were used to measure the associations between prior authorization and IBD-related healthcare utilization within 180 days and corticosteroid dependence at 90 days, with adjustment for insurance type, demographics, and disease severity–related characteristics. Median biologic initiation time was 21 days. Prior authorization and complicated prior authorizations (requiring appeal, step therapy, or peer-to-peer review) were associated with 10.2-day (95% confidence interval [CI] 8.2 to 12.3) and 24.6-day (95% CI 16.4 to 32.8) increases in biologic initiation time, respectively. Prior authorizations increased the likelihood of IBD-related healthcare utilization within 180 days by 12.9% (95% CI 2.5 to 23.4) and corticosteroid dependence at 90 days by 14.1% (95% CI 3.3 to 24.8). Prior authorizations are associated with prolonged biologic initiation time and increased IBD-related healthcare utilization. Minimizing prior authorization–related delays may expedite biologic delivery and reduce the risk of IBD-related healthcare utilization.
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影响因子：
--
作者：
Bursac, Zoran;Gauss, C Heath;Williams, David Keith;Hosmer, David W
通讯作者：
Hosmer, David W
影响因子：
4.9
作者：
Costa, Joao;Magro, Fernando;Vaz-Carneiro, Antonio
通讯作者：
Vaz-Carneiro, Antonio
影响因子：
3.2
作者：
Dickens, David S.;Pollock, Brad H.
通讯作者：
Pollock, Brad H.
DOI：
10.1056/nejmoa1915315
发表时间：
2020-06-04
期刊：
The New England journal of medicine
影响因子：
--
作者：
Minard-Colin V;Aupérin A;Pillon M;Burke GAA;Barkauskas DA;Wheatley K;Delgado RF;Alexander S;Uyttebroeck A;Bollard CM;Zsiros J;Csoka M;Kazanowska B;Chiang AK;Miles RR;Wotherspoon A;Adamson PC;Vassal G;Patte C;Gross TG;European Intergroup for Childhood Non-Hodgkin Lymphoma;Children’s Oncology Group
通讯作者：
Children’s Oncology Group
影响因子：
29.4
作者：
Hyams, Jeffrey;Crandall, Wallace;Baldassano, Robert
通讯作者：
Baldassano, Robert