A Single-Center Experience in Quality Improvement for IBD Preventative Care
Bibliographic record
Abstract
Introduction: IBD care is very complex, and American Gastroenterological Association(AGA) developed clinical performance measures for adult patients to improve therapeutic optimization. We applied these measures and have begun to see improved care by implementing them. Methods: Retrospective chart review of IBD patients in our center’s GI clinic was done to assess the measures below. Afterwards,a template was instituted to improve quality in said measures. Results: Of 88 patients evaluated, the majority (81, 92%) were male. Of these 88,51 (58%) had a diagnosis of Crohn’s disease, while 35 (40%) were labeled with ulcerative colitis,with the remaining labeled indeterminate. Fourteen (15.9%) were placed on corticosteroids, 22 (25%) had been exposed to immunomodulator therapy, and 13 (14.8%) had been trialed on biologic therapy. DEXA scanning performed in 15 (17%), vitamin D given in 43 (48.9%) and calcium in 37 (42%). All females did get PAP smear screening, however eye and skin evaluation was only done in 5 (5.7%) and 3 (3.4%) patients, respectively. Twenty-four (27.3%) had a positive smoking screen, with only 7 having cessation counseling. Conclusion: In a survey of nearly 200 IBD patients, less than one-half of those who were eligible for the flu vaccine had received it within that year, and less than 10% of eligible patients had ever received the pneumococcal vaccine. Our study is consistent with other studies from the United States, Canada, Europe, and Australia which have identified similar gaps in care or in provider knowledge, suggesting that these deficiencies are widespread and not confined to a specific geographic region. Vaccines are important, particularly in those on strong immunosuppressive therapy. Women with IBD on immunosuppressants are at increased risk for abnormal PAP smears. Those on immunomodulators have higher risk of skin cancer. They are at higher risk of bone loss and need osteoporosis screening and vitamin D/ calcium as per the guidelines. Education of health care providers involved in care of IBD patients and implementing these measures has preliminarily shown marked improvement in the care provided to our patients.Table 1Table 2Figure 1
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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 | 0.010 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.014 | 0.002 |
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".