P725 The impact of an integrated model of care for patients with inflammatory bowel disease in Canada
Notice bibliographique
Résumé
Background: Integrated models of care (IMC) for inflammatory bowel disease (IBD) have been implemented to improve the quality of care and disease management, and reduce adverse outcomes. Studies providing a systematic assessment of the impact of IMC for IBD on health care utilization have not previously been undertaken. This study compared health care services and medication use for IBD patients who were and were not exposed to an IMC. Methods: A retrospective population-based cohort study was conducted between 2009 and 2015 using administrative health data for the province of Saskatchewan (SK), Canada. The SK IMC for IBD (the Multidisciplinary IBD Clinic—MDIBDC) was introduced in 2009. Patients with IBD were identified with a validated administrative case definition applied to hospital and physician billing records. The criteria for measuring exposure to the IMC included baseline and follow-up visits with MDIBDC physicians. Cox proportional hazard regression models with propensity-score matching were used to test for differences in IBD-related hospitalizations, surgeries, and medications use (5-aminosalicylic acid—5-ASA, immune modulator—IM, and biologics) between patients with and without MDIBDC exposure. Adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated. Conditional logistic regression was used to test for differences in the probability of corticosteroid dependency (CsD) over a 6-month period. Results: The study included 2312 IBD patients. In the sample, the mean age was 44.1 (SD=15.8) years, 51.5% were women, 74.7% had urban residence, 39.6% had ulcerative colitis (UC), and 24.3% were defined as exposed. The exposed group had a lower rate of IBD-related surgeries (HR=0.72, 95% CI 0.57–0.91), higher rate of IM (HR=1.75, 95% CI 1.48–2.05), higher biologic use (HR=1.75, 95% CI 1.48–2.05), and lower 5-ASA use (HR=0.79, 95% CI 0.68–0.92) than the non-exposed group. Analyses stratified by disease type revealed a lower rate of IBD-related hospitalization in exposed UC patients (HR=0.71, 95% CI 0.53–0.94). The odds of CsD amongst patients with UC in the exposed group was 0.39 (95% CI 0.15–0.98) that of the non-exposed group. No significant differences in CsD were identified in the full group analysis. Conclusions: Differences in adverse disease outcomes between exposed and non-exposed patients reflect the improved quality of care provided within an IMC for IBD. Increased use of steroid-sparing maintenance therapies, specifically IM and biologics, is an indicator of improved access to IBD therapies, as is the lower CsD use amongst patients with UC. Integrated models can positively impact the health care outcomes of patients with IBD, and, subsequently, lead to effective use of health care resources.
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 machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 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 source (Gemma direct ou Codex distillé), 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 ».