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，主要是医学管理。次优的药物治疗选择可能导致代价高昂的不良健康和保健结果，包括维持皮质类固醇的使用、住院治疗和手术干预。有证据表明，抗肿瘤坏死因子拮抗剂（anti- tnf）可改善无治疗禁忌症的年轻IBD患者的不良结局。然而，老年患者的患病率正在增加，目前占140万美国IBD患者的20%左右。最近的数据表明，老年IBD患者的护理可能存在质量差距。无抗肿瘤坏死因子治疗禁忌症的老年IBD患者抗肿瘤坏死因子的使用情况和治疗结果尚不清楚，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，我们的认识存在更大的差距。为了确保高质量的护理和医疗资源的合理利用，检查药物治疗是至关重要的

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.