DOZ047.83: Coordination of care through implementation of a multidisciplinary clinic for patients with esophageal atresia and tracheoesophageal fistula
Bibliographic record
Abstract
Abstract Introduction Esophageal atresia/tracheoesophageal atresia (EA/TEF) is a multisystem congenital anomaly. Initial treatment is complex and ongoing complications are numerous. Coordination of care has been shown to reduce costs and hospitalizations in complex populations. A previous study at our center demonstrated that children with EA/TEF lacked coordinated care. A multidisciplinary clinic was established to provide coordinated care, screen for complications, provide anticipatory guidance, and improve outpatient access. Methods This single-center retrospective cohort study included children with EA/TEF born between March 2005 and March 2011 and enrolled in the clinic. Patients with EA alone were excluded. A chart review was completed to identify demographics, hospitalizations, emergency visits, clinic visits, coordination of outpatient care, and adherence to the intended clinic schedule. Results Twenty-five patients were included; 84% had a C-type EA/TEF. Multidisciplinary clinics had an average of 4.3 health care providers (1.75 physicians) per visit. Adherence to the visit schedule was 91.4%. The average length of stay (46.2 + 37.9 days) for the initial hospital admission was similar to the previous study cohort. Subsequent hospital admissions were reduced in number and length of stay, most notably in the first two years of life (0–1 year: 1.28 + 1.2 admissions/patient; 10.7 + 19.1 days/admission; 1–2 years: 0.6 + 0.76 admissions/patient; 3.7 + 3.2 days/admission). Conclusions Multidisciplinary care clinics for medically complex children such as those with EA/TEF can improve care through coordination of visits with multiple health care providers and may contribute to reduced use of acute care services.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 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".