P633 Harmonisation of quality of care in an IBD centre impacts disease outcomes: importance of structure and process indicators
Bibliographic record
Abstract
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.
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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 | 0.033 | 0.094 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.006 | 0.003 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".