An exploratory analysis of healthcare costs and utilization of pediatric patients with Crohn's disease.

OBJECTIVE: To evaluate the healthcare costs and resource utilization associated with pediatric Crohn's disease (PCD) from a payer perspective. METHODS: A retrospective analysis was conducted using claims from 1 January 2003 through 31 December 2006 from the HealthCare Partners database. Patients were younger than 18 years of age, had a new diagnosis of PCD, and continuous health plan eligibility 6 months before and 12 months after the disease index date (the date of the first claim with a PCD diagnosis). For comparison, a non-PCD cohort was matched on age, sex, and birthday (within 30 days). RESULTS: Data from 30 patients with PCD and 10,864 non-PCD controls were included. The total cost per member per month (PMPM) for the PCD cohort was $2,547 compared with $101 for the non-PCD cohort. Inpatient admissions accounted for the largest portion (54%) of the total cost PMPM for PCD patients. There were 500 admissions per thousand members per year (PTMPY) for the PCD cohort and 11 admissions PTMPY for the non-PCD cohort. The average lengths of stay were 7.6 and 4.4 days for the PCD cohort and the non-PCD cohort, respectively, and the inpatient costs PMPM were $1,409 and $18, respectively. Costs and resource utilization were also higher for PCD patients treated with systemic therapies. CONCLUSION: PCD was associated with higher costs and resource utilization, compared with non-PCD controls, primarily driven by inpatient stays. Treating PCD appropriately before the disease progresses to a level requiring hospitalization may help reduce the costs associated with this disease.

Assessing endoscopic colorectal screening adherence in an emergency department population.

OBJECTIVES: Colorectal cancer (CRC) has the second highest cancer-related mortality rate in the United States. However, CRC screening rates, particularly by endoscopy, are dismally low. The purpose of this study is to determine the factors associated with adherence to endoscopic screening using the emergency department (ED) population. METHODS: Structured interviews in English or Spanish were administered to 122 patients, aged > or =50 in the ED of an urban academic medical center. Questions focused on sociodemographic and medical factors, knowledge deficits and attitudes towards screening as well as psychosocial factors that may be associated with screening adherence. Compliance with current screening guidelines was measured by self-report. RESULTS: The population was sociodemographically diverse. There were significant differences across ethnic groups with regards to awareness and attitudes toward screening as well participation in screening. Age >65, Spanish language during the interview, white ethnicity and having a primary care physician were significant correlates of adherence to screening colonoscopy. Once decisional balance (conspros) was entered into the model, the other factors were no longer significant. Furthermore, physician referral was the strongest correlate of adherence to endoscopic screening. CONCLUSIONS: There are significant sociodemographic, medical and psychosocial barriers preventing CRC screening adherence in ED patients, yet the strongest correlate is physician referral. The ED encounter may serve as an opportunity to provide information and referral for CRC screening.