A236 REAL LIFE HEALTH CARE UTILIZATION IN PEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN THE ERA OF BIOLOGICS
Notice bibliographique
Résumé
Abstract Background The burden associated with the management of pediatric patients with inflammatory bowel disease (IBD) has been rising over the past years as the incidence of IBD is increasing in children. In addition, the widespread use of biologics and a treat-to-target approach also contributes to the increase of healthcare utilization. Aims The purpose of this study was to assess the health care services utilization and the associated factors in a prospective cohort of children diagnosed with IBD in Quebec. Methods Patients diagnosed from 2013 to 2015 and followed up until the transfer to adult care were identified in our IBD database. Data on IBD related services and treatments: imaging procedures, hospitalizations and outpatient visits, medications from diagnosis to transition was extracted. We analyzed the healthcare utilization according to the baseline disease severity (pediatric Crohn’s disease activity index (PCDAI) or pediatric ulcerative colitis activity index (PUCAI)) at diagnosis, and according to exposition to intravenous biologics. Results A total of 144 patients were included in the study [(77 males), Crohn’s disease (98), Ulcerative Colitis (31) and IBD-unclassified (15); median (interquartile(IQR)) age at diagnosis 15.2(14.3–16.3)]. The median(IQR) duration of follow up at the IBD clinic was 2.9 (1.8–3.9) years. The median (min-max) number of imaging procedures varied largely: esophagogastroduodenoscopy 1(0–2), Colonoscopy 1(1–6), abdominal ultrasound 1(0–13), abdominal MRI 1(0–4), tomodensitometry 0(0–2), Bone densitometry 1(0–5). Patients had various follow-up encounters (median (min-max)): outpatient visits 9 (1–28), IBD nurses phone follow-up 4(0–33). A total of 64.6% of patients had at least one hospitalization [median(min-max) number 1(0–10); median duration 4(0–150 days)] and 35.41% had at least one emergency room visit. Baseline disease severity did not predict the disease burden: the mean number of encounters was 3.0 /year in the moderate/severe group as compared to 2.5/year in the mild group; P= 0.61. Among the, 63.5% of patients exposed to an intravenous biologic (Infliximab or Vedolizumab), those exposed earlier (<3 months after diagnosis) used more health care services (mean = 3.3/year) than those exposed later (mean =2.23/year); P <0.0001. In addition, the median (interquartile (IQR)) cumulative days of healthcare utilization (missing school days) for patients treated with intravenous biologics was 48.5 (32.4–67.9) days during pediatric care. Conclusions Adolescents with IBD have several encounters between the diagnosis and transition to adult care. Disease severity at diagnosis was not related to a higher level of health services utilization during follow-up. However, treatment with intravenous biologics was associated with a high health service utilization and school missing during follow-up. Funding Agencies None
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 | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 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) | 0,003 | 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 ».