Impact of provider specialty on the diagnosis and management of systemic lupus erythematosus in the American Indian/Alaska Native population
Notice bibliographique
Résumé
Systemic lupus erythematosus (SLE) is a complex disease that is traditionally diagnosed and managed by specialists, typically rheumatologists. Higher SLE prevalence in racial/ethnic minorities such as American Indian/Alaska Native (AI/AN) people, often residing in areas with less access to rheumatologists, may necessitate diagnosis and management of SLE by primary care providers (PCP) in some cases. The purpose of this analysis was to identify areas of potential difference between PCP and specialist diagnosis and management of SLE in a population-based lupus registry of AI/AN people. All individuals with SLE meeting our inclusion criteria were selected from the 2009 Indian Health Service lupus registry population. Inclusion in this analysis was limited to individuals with a final diagnosis of SLE made by a PCP or specialist (dermatologist, nephrologist or rheumatologist) and documented in the medical record. Based on medical record abstraction, SLE classification criteria were validated for each individual. Testing for biologic markers of SLE and medication use at any time during the course of the disease was also abstracted. Of the 320 patients identified with a documented physician diagnosis of SLE, 71 had been diagnosed by a PCP. SLE diagnosis by a specialist was associated with a higher median number of American College of Rheumatology (ACR) classification criteria (5 vs. 2), a higher percentage of patients meeting the definition of SLE by ACR criteria (79% vs. 22%), the Boston Weighted criteria (82% vs. 32%), and an abridged version of the Systemic Lupus International Collaborating Clinics criteria (83% vs. 35%) ( P < 0.001 for all comparisons). Additionally, specialist diagnosis was associated with an increased proportion with any testing for anti-double-stranded DNA antibody (93% vs. 73%) and complement C3 and C4 (84% vs. 52%) documented in the medical record ( P < 0.001 for all). Lastly, specialist diagnosis was associated with ever treatment with hydroxychloroquine (86% vs. 64%, P < 0.001) as documented in the medical record at any time during their disease course. Within the population studied, specialist diagnosis of SLE was associated with a higher number of SLE classification criteria met, a higher percentage of patients tested for biomarkers of disease, and a higher percentage of patients ever treated with hydroxychloroquine.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».