P633 Harmonisation of quality of care in an IBD centre impacts disease outcomes: importance of structure and process indicators
Notice bibliographique
Résumé
Optimal management of IBD requires harmonised monitoring and treatment pathways. We aimed to evaluate the quality of care at the McGill University Health Center (MUHC) IBD Center using quality of care indicators (QIs) including patient assessment strategy, monitoring, treatment decisions, and outcomes. The MUHC IBD centre was officially established in July 2016 with a structure based on the PACE (Promoting Access and Care through Centers of Excellence) program developed by the Crohn’s and Colitis Canada organisation. We retrospectively analysed the quality of care IBD patients were receiving before and after their referral to MUHC IBD specialists and up until their first visit at the newly established MUHC IBD centre. Consecutive patients were included with an outpatient visit (‘index visit’) at the MUHC IBD Centre from July 2016 to December 2016. Demographic variables, outpatient visits, inpatient stays including IBD-related surgery, laboratory, imaging, and endoscopy data, current medications and/or changes in medications, and vaccination profiles were captured. In total, 1357 patients (64.4% Crohn’s disease (CD)) were included. At referral, a large proportion of patients were objectively re-evaluated (ileocolonoscopy: 79%, cross-sectional imaging: 15.6% of CD patients had abdomino-pelvic MRI or CT and 23.6% abdominal US, biomarkers CBC, CRP and FCAL: 89.9%, 81.9% and 16.5%, respectively). Therapeutic strategy was changed in 53.6% with 22.5% of patients starting biologics. Tight objective patient monitoring was applied also during follow-up (colonoscopy: 79%, cross-sectional imaging: 61.8% within 2 years prior to the index visit). Additional colonoscopy and imaging to evaluate disease activity was ordered in 32% and 19% within 6 months after the index visit. The frequency of therapeutic drug monitoring (TDM) was escalated following the establishment of the IBD centre. Maximum therapeutic step was accelerated with 48.8% of patients on biological therapy at the time of index visit. Treatment was changed in 17.8% of patients (active disease: 40.3%, patients in remission: 7.2%, p < 0.01). The need for surgery (4.3%) and hospitalisation (7.6%) were relatively low, while 16.8% of patients needed an IBD-related ER visit within 6 months after index visit. Our data support that tight monitoring was applied at the MUHC IBD centre with a high emphasis on objective patient (re)evaluation, timely access and accelerated treatment strategy at referral or during follow-up. QIs mapped in this study can serve as reference data for comparison on structure, process algorithms and outcomes for IBD centres worldwide.
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 | 0,033 | 0,094 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,006 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,006 | 0,003 |
| Science ouverte | 0,001 | 0,004 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 ».