Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

When a patient is admitted to the hospital, what is the comparative utility of continuing biologic immunomodulators that are normally used as outpatient treatment to control chronic medical conditions?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

tumor necrosis factor-alpha inhibitors, disease-modifying antirheumatic agents, monoclonal antibodies

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

predominantly Medicare and Medicaid patients at this institution, indications include crohn's disease, inflammatory bowel disease

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

NA

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Maintaining symptomatic relief of chronic conditions while the patient is admitted

Describe any health-related risks, side effects, or harms that you are concerned about.

The primary concern is the detrimental effect patients might experience from missing a dose of these immunomodulators

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Arthritis and nontraumatic joint disorders

AHRQ Priority Populations

• Low income groups

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

This topic is important because many of these drugs are very expensive. They are mostly given as outpatient treatment on periodic (ie, less frequently than daily) schedules. Therefore, there is concern they may not be necessary throughout a typical short hospitalization, where the drug cost would not be reimbursed. Additionally, while patients are hospitalized, their immune function is typically compromised, which may be worsened by administration of these medications.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Costly intervention, lack of systematically collected data

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Data regarding the discontinuation of these drugs during an inpatient stay is scant, and the decision may be based on the possible detrimental effect of missing a dose.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

It will help develop a policy on appropriateness of purchase and administration of these drugs.

Describe the timeframe in which an answer to your question is needed.

The cost of these drugs is unlikely to decrease in the near or remote future, so as soon as possible.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

It will help develop a policy on appropriateness of purchase and administration of these drugs.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

Personal Research