Predictors, Use & Consequences of Biologics & Other Agents in Older IBD Patients

描述(由申请人提供)：炎症性肠病(IBD)是一种资源密集型疾病，主要通过药物治疗。次优的药物治疗选择可能会导致昂贵的不良健康和医疗结果，包括维持皮质类固醇的使用、住院和手术干预。有证据表明，抗肿瘤坏死因子拮抗剂(抗肿瘤坏死因子拮抗剂)可以改善没有治疗禁忌症的年轻IBD患者的不良结局。然而，老年患者的患病率正在上升，目前约占美国140万IBD患者的20%。最近的数据表明，老年IBD患者的护理可能存在质量差距。没有治疗禁忌症的老年IBD患者的抗肿瘤坏死因子利用率和预后尚不清楚，对于有抗肿瘤坏死因子治疗禁忌症的老年IBD患者的治疗选择，我们的了解还有更大的差距。为了确保高质量的护理和适当地利用卫生保健资源，检查药物疗法至关重要。 老年IBD患者的选择和不良结局。这项拟议的研究将分析年龄在65岁及以上的10,479名患有炎症性肠病的联邦医疗保险受益人，以解决以下目标：(1)检查在没有抗肿瘤坏死因子治疗禁忌症的老年炎症性肠病患者中使用抗肿瘤坏死因子的临床和社会人口学预测因素，(2)比较在没有禁忌症的老年炎症性肠病患者中使用抗肿瘤坏死因子药物的人和不使用抗肿瘤坏死因子药物的人之间的健康和保健结果(维持类固醇的使用、住院和手术干预)，以及(3)描述有禁忌症的老年炎症性肠病患者的常见治疗方案。这项研究项目将为完善医疗保险和医疗补助服务中心最近发布的IBD质量指标提供洞察力。

DESCRIPTION (provided by applicant): Inflammatory bowel disease (IBD) is a resource-intensive condition that is primarily medically managed. Suboptimal drug therapy selection may result in costly adverse health and healthcare outcomes, including maintenance corticosteroid use, hospitalizations, and surgical interventions. There is evidence that anti-tumor necrosis factor antagonists (anti-TNFs) improve the adverse outcomes experienced by younger IBD patients who do not have contraindications to treatment. However, older patients are increasing in prevalence and currently represent ~20% of the 1.4 million Americans with IBD. Recent data suggests that there may be a quality gap in the care of older IBD patients. Anti-TNF utilization and the outcomes experienced by older IBD patients without contraindications to treatment are not known, and there is an even bigger gap in our knowledge about treatment selection in older IBD patients with contraindications to anti-TNF therapy. To ensure high quality of care and appropriate utilization of healthcare resources, it is critically important to examine drug therapy selection and adverse outcomes in the older IBD patients. The proposed research will analyze a cohort of 10,479 Medicare beneficiaries with IBD who are age 65 and above to address the following aims: (1) to examine clinical and socio-demographic predictors of anti-TNF use in older inflammatory bowel disease patients without contraindications to anti-TNF therapy, (2) to compare health and healthcare outcomes (maintenance steroid use, hospitalizations, and surgical interventions) between anti-TNF users and anti-TNF non-users among older IBD patients without contraindications, and (3) to describe common treatment regimens in older IBD patients with contraindications. This research project will provide insight to refine the IBD qualiy measures that were recently released by the Center for Medicare and Medicaid Services.