A230 NOT ALL PATIENTS WITH GASTROINTESTINAL COMPLAINTS REQUIRE SPECIALIST CARE: TWO YEAR OUTCOMES FROM AN ENHANCED PRIMARY CARE PATHWAY
Bibliographic record
Abstract
High referral volumes to digestive disease specialists in Canada highlight the ubiquity of gastrointestinal disorders. Yet, due to demand-supply mismatch, wait times for specialist consultation continue to grow, exceeding consensus targets. At our institution, a single point of entry model is used to centralize intake. Recently, an Enhanced Primary Care (EPC) pathway was created to identify certain low-risk patients who do not require immediate specialist consultation. These patients are managed by their primary care physician with support from co-developed best practice guidelines. This study aims to evaluate the overall safety and outcomes for patients declined by our central triage referral system. All patients triaged to the EPC pathway from January 1, 2015–January 31, 2017 were identified. The subset that re-entered the system through an emergency room (ER) visit and/or re-referral to a specialist was determined. Anonymized patient data, including demographics, referral indication, and referral closure date were abstracted and correlated with endoscopic and histopathologic findings. Clinically significant findings were defined as those imparting significant morbidity or need for further specialist management. During the 25-month study period, a total of 1266 unique closed referrals were captured. 136 patients (10.7%) had a subsequent gastrointestinal-related ER visit, of which, 45 (33%) went on to endoscopy. Overall, 192 patients (15.2%) re-entered the referral system and had assessment with esophagogastroduodenoscopy (67%), colonoscopy (17%), sigmoidoscopy (2%), or bidirectional endoscopy (14%). The median time from referral closure to endoscopy was 186 days (range 6–804). The majority of patients were female (60.9%) with an overall median age of 43 years (range 18–87). The most common indications for re-referral were dyspepsia (42%), gastroesophageal reflux (28%), and suspected irritable bowel syndrome (20%). Overall, clinically significant findings were identified in only 4 of 214 procedures (2%). These included 2 patients with esophagitis, 1 advanced adenoma, and 1 benign peptic stricture. No patients were found have malignancy, inflammatory bowel disease, microscopic colitis, or celiac disease. Fully 148 of 214 procedures (69%) were completely normal. Not all patients referred for gastrointestinal consultation require specialist care or endoscopy. Through careful patient selection, the use of the EPC pathway is both safe and effective in identifying low risk patients who are most appropriately managed within primary care. This facilitates optimization of consultative and endoscopic resources for higher risk patients. Division of Gastroenterology, University of Calgary
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".