The pediatric intermed: A new clinical -decision making tool for proactive evaluation of psychosocial stress in children with IBD
Bibliographic record
Abstract
IBD manifest themselves in children and adolescents in up to 1/3 of those who will eventually develop these conditions. The chronic nature of the disease and treatments is often a significant stressor for children and families. Failure to address psychosocial issues may lead to greater risk for poor treatment adherence and disease relapse, higher heath care utilization, and increased psychiatric co-morbidity. As such, improvement in health care providers' capacity to systematically identify factors contributing to case complexity in a simplified reproducible manner offers significant potential for improving outcomes for children/youth with IBD. The adult INTERMED (Steifel et al., 2006) is a clinical decision-support tool that provides indicators of biological, psychological, social and health care needs, as well as an overall index of case complexity. The tool is efficient to administer and successfully detects psychosocial needs, referral to effective services and improved health care practices and outcomes. However, no comparable validated tools exist for use with children. To address the unique developmental and social contexts of children, a pediatric adaptation of the Intermed tool (PIM) was developed The PIM adopts a life-chart methodology to identify of areas of high need and risk. The focus of the present study was to examine the psychometric properties of the new PIM tool in children/youth diagnosed with IBD. Children and parents participated in a semi-structured interview with a clinical nurse who then rated the 34-PIM items. To examine the construct validity of each PIM domain (biological, psychological, social, caregiver/family, health system) participants completed questionnaires assessing social and psychological functioning, parent/family stress, and quality of life. Information about disease status, and health care utilization was obtained from medical chart review. Initial results from 48 patients indicate very good item inter-rater reliability for the PIM (mean reliability = 0.82). The Cronbach alphas for the overall complexity scale and for each of the domain scores were very acceptable (ranging from .56-.90). Correlational analyses suggest a high degree of validity for each of the PIM domains. PIM Biological score related significantly to PCDAI scores (r = 0.72) and child functional disability (r = 0.53). The PIM Psychological score was highly correlated with childhood depression (r = 0.55) and externalizing problems (r = 0.46). Higher PIM social needs were significantly related to decreased social and academic competence (r = −0.58 and 0.66, respectively) and less community participation (r = 0.39). PIM Family was significantly related to family life stress and decreased resources (r = 0.44) and greater parenting stress (r = 0.30). Finally, the overall PIM Complexity Score was associated with greater health care utilization (more calls to IBD nurse (r = 0.30) /extra GI outpatient visits (r = 0.32)), as well as IBD specific Quality of Life (r = −0.41). The PIM is an easily administered, psychometrically reliable and valid tool for identifying the psychosocial and health care needs of children with IBD, to facilitate individualized care planning. We speculate that early identification and intervention of health stressors will provide opportunities for improved care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".