A78 IMPACT OF IMPLEMENTING A RAPID ACCESS CLINIC IN A HIGH-VOLUME INFLAMMATORY BOWEL DISEASE CENTER: ACCESSIBILITY, REASOURCE UTILISATION AND OUTCOMES
Notice bibliographique
Résumé
Emergency situations in inflammatory bowel diseases (IBD) put significant burden on the patient and healthcare system as well. We aimed to prospectively measure indicators of quality-of-care, after implementation of a new rapid access clinic (RAC) at the McGill University Health Centre (MUHC) tertiary care IBD center. The RAC provides patients an opportunity to be evaluated by IBD specialists urgently without having to present to the emergency department. RAC was structured by providing an emergency contact email address to the patients, with a specific document explaining the pertinent symptoms that merit utilization of this access avenue. Each email was read and reviewed by a specialized IBD nurse or physician. Patient access, resource utilization and outcome parameters were collected from MUHC IBD Center Rapid Access clinic including consecutive patients who contacted the RAC via email between July 2017 and September 2018. 261 patients (44.1% men, mean age: 39 years, CD: 64% [L3: 46.2%, B2–3: 31.8%], UC: 32% [extensive colitis: 56.6%], biological therapy: 61.6%, previous surgery: 20.4%) were included. 85.7% of requests were deemed appropriate for a rapid appointment. The reason for RAC appointment was potential disease flare in 62.5% of patients. The median time to RAC visit was 3 days (IQR: 1–6 days) from the first point of contact (email/phone) by the patient. Patients had a fast track evaluation with optimized resource utilization in the majority of cases. CRP and fecal calprotectin were the most common measures of disease severity performed, 85.2% and 62.5%, respectively. Clostridium difficile stool test and stool culture test were performed in 43.8% and 42.4% of the patients. The frequency of colonoscopy and flexible sigmoidoscopy following the RAC visit were 22.9% and 6.7%. Only a minority of patients underwent CT (7.1%) and MR (1%) imaging. A change in therapy occurred in 57.0% of patients. Within 30 days from the index visit, 21 patients (19 patients with IBD related symptoms) required ER. 8 ER visits were initiated during the RAC visit and resulted in admission, 7 other patients had unplanned ER visit due to continuous IBD activity. Only 5 patients who were screened by the RAC physician and deemed not to require an urgent consultation presented at the ER (unplanned ER visit rate were 1.8%, no patient required admission). Implementation of an RAC improved healthcare delivery by avoiding unnecessary ER visits and by increasing access to an IBD center. Patients had a fast track evaluation with optimized resource utilization. Data presented here can serve as example for a more optimal cost utilization for future IBD centers. McGill Department of Medicine CAS Research Support
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) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 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 ».