A85 IMPROVING OUTCOMES IN THE PEDIATRIC TO ADULT CARE TRANSITION IN IBD (IMPACT IBD)
Bibliographic record
Abstract
Pediatric-to-adult transition of care in Inflammatory Bowel Disease (IBD) can be challenging for patients between 18–25 and the lack of continuity of care is perceived to be causative in loss to follow-up, treatment disruption and poor clinical outcomes. The objective of this study was to determine whether regular email contact with a single IBD nurse could improve health outcomes when delivered during the last 3 months of pediatric care and the first 9 months of adult care. Patients were randomized in a 1:1 ratio to the intervention and control groups. Randomization was stratified by center (SickKids, McMaster) and anticipated post-transfer setting (academic vs. community). All individuals enrolled completed a baseline questionnaire (disease phenotype, medications, disease activity (Harvey Bradshaw Index (HBI), Pediatric Ulcerative Colitis Activity Index (PUCAI)), transition readiness (Transition Readiness Assessment Questionnaire (TRAQ), patient satisfaction (CACHE questionnaire), IBD knowledge (Crohn’s and Colitis Knowledge Questionnaire (CCK)). This was repeated every 6 months. MyHealth Passport was distributed twice. The IBD nurse interacted monthly with intervention patients and IBD educational modules were delivered every two months. This study was REB approved. We compared IBDQ, HBI, PUCAI, TRAQ, CACHE, CCK scores between groups. Paired Students t-test or the Wilcoxon ranksum test were used to assess for statistically significance (p-value of <0.05). 151 patients were recruited to the study (72 intervention, 74 control, 5 lost). 78% of the population was from SickKids. 76% of the population were transferred to an adult academic setting. 74% had Crohn’s Disease. 27% had perianal disease and 10% had pediatric growth delay. 86% of UC patients had pancolitis. The mean age was 17 with a mean age of diagnosis 13. 19% had prior surgery, 66% were on anti-TNF therapy and 93% had self-reported active familial psychosocial support. There was no significant difference at 12 months between intervention and control groups with respect to HBI, PUCAI, IBDQ, CACHE. At 12 months the intervention group scored lower on TRAQ (3.51 vs 3.61, p=0.02). At 12 months the intervention group scored higher on CCK (14.61 vs 13.57 p=0.05). When the difference between 12 month and baseline scores for each group were analysed, there was no difference in HBI, PUCAI, CACHE, CCK. The difference in IBDQ was larger in the control group (-31.90 vs -21.11, p<0.001). Standardized routine email interactions between an IBD nurse and patients does not reliably improve most traditional disease outcomes. It is unclear whether a longer duration of intervention, an in-person component to the intervention and/or a change in metrics are needed to improve impact. CCC
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 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".