P155 Adherence to quality indicators among patients with inflammatory bowel disease: an international comparative analysis
Bibliographic record
Abstract
Deficiencies in quality of care have been identified in a variety of inflammatory bowel disease (IBD) care domains, such as appropriate use of steroid sparing agents and preventative health maintenance measures. Many of these differences are due to practice variations among providers. The aim of this study was to assess variations in adherence to IBD-specific quality indicators across two tertiary referral centres. A retrospective chart review measuring inpatient and outpatient quality indicators was conducted at Mount Sinai Hospital, Toronto, Canada (MSH) and the University of Leuven, Leuven, Belgium (UZL). The data were summarised using descriptive statistics and differences in quality indicators were assessed using the Fischer’s exact test. A p-value of <0.05 was considered significant. Among 450 outpatients (MSH = 225, UZL = 225), 269 (59.8%) had CD, 169 (37.7%) had UC, and 12 (2.7%) had IBD-U. All patients at UZL had undergone a post-operative colonoscopy to assess for recurrent disease within 12 months of surgery, when compared with 78% of patients at MSH (p < 0.001). More patients at MSH had been on a prolonged course of steroids, defined as a period of greater than 3 months (57.4% vs. 6.4%, p < 0.001), however no differences were seen in the use of steroid sparing therapy between the two sites. More patients at MSH underwent routine bone density screening (12.2 vs. 4.4%, p = 0.003). However, there were no significant difference in screening rates among patients who had been on a prolonged course of steroid (17.09 vs. 28.57%, p = 0.287). Dysplasia surveillance according to recommended intervals was more commonly performed at MSH (83.5 vs. 64.8%, p < 0.010). Flu and pneumococcal vaccinations were more often recommended at UZL (80.5 vs. 53.7% MSH, p < 0.001). Among 352 inpatients (MSH = 194, UZL = 158), more patients at MSH received DVT prophylaxis (86.1 vs. 31.7%, p < 0.001) and underwent C. difficile testing (70.1 vs. 57.6%, p = 0.015). There was no significant variation in initiation of salvage therapy after 7 days of IV steroids among inpatients with acute, severe UC (75.68 vs. 58.33%, p = 0.170). There were important differences in adherence to many of the quality indicators across two IBD referral centres. These differences underscore the notion that practice variations exist in managing complex IBD patients, even at IBD centres of excellence. Moreover, the regional variations noted underscore the importance of adapting quality improvement initiatives to the local context.
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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 | 0.003 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.007 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| 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".