Identifying perianal fistula complications in pediatric patients with Crohn's disease using administrative claims

Jeremy Adler

Crohn’s disease commonly causes perianal fistulas which can cause abscesses and infections in any organ in the pelvis. These are serious complications which can have a major impact on quality of life and can have long-term implications. They are difficult to treat, require expensive medications, and commonly require surgery. Despite advances in medical therapies and surgical techniques, fistulas commonly reoccur.

One of the many limitations to improving fistula care or developing preventive strategies has been the limited amount of research being done on these complications of Crohn’s disease. The use of large administrative databases for research on fistulas has been hampered by a lack of validated case definition for perianal fistula complications. Prior studies that have used the perianal fistula billing code, which has never been validated, and has led to substantially under-represented incidence of perianal fistulas.

Dr. Adler performed a retrospective cohort study in which we developed candidate case definitions for perianal fistulas, and tested them in comparison to the electronic medical record (considered the gold standard). The best performing case definition identified >60% more cases of perianal fistulas than the standard billing code definition.

This new validated case definition is important because it will enable researchers to apply these claims-based methods to other settings for evaluation of health services utilizations as well as to assess the comparative effectiveness of prevention and treatment strategies.

These findings have been published in PLOS ONE

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