P376 Real life health care utilisation in paediatric patients with inflammatory bowel disease in the era of biologics
Bibliographic record
Abstract
Abstract Background The burden associated with the management of paediatric patients with inflammatory bowel disease (IBD) has been rising as the incidence of IBD is increasing in children. In addition, the widespread use of biologics and a treat-to-target approach also contributes to the increase of healthcare utilisation. Methods The purpose of this study was to assess the health care services utilisation and the associated factors in a prospective cohort of children diagnosed with IBD in Quebec, Canada. Patients diagnosed from 2013 to 2015 and followed up until the transfer to adult care were identified in our IBD database. Data on IBD related services and treatments: imaging procedures, hospitalisations and outpatient visits, medications from diagnosis to transition was extracted. We analyzed the healthcare utilisation according to the baseline disease severity (paediatric Crohn’s disease activity index or paediatric ulcerative colitis activity index) at diagnosis, and according to exposition to intravenous biologics. Results In total, 144 patients were included in the study [(77 males), CD (N = 98), UC (N = 31) and IBD-U (N = 15); median (interquartile(IQR)) age at diagnosis 15.2 (14.3–16.3) years]. The median (IQR) duration of paediatric follow-up was 2.9 (1.8–3.9) years. The median (min-max) number of imaging procedures varied largely: esophagogastroduodenoscopy 1(0–2), colonoscopy 1(1–6), abdominal ultrasound1(0–13), abdominal MRI 1(0–4), tomodensitometry 0(0–2), bone densitometry 1(0–5). Patients had various follow-up encounters (median(min–max)): outpatient visits 9(1–28), IBD nurses phone follow-ups 4(0–33). Sixty-four per cent of patients had at least one hospitalisation [median(min–max)1(0–10); median duration 4(0–150 days)] and 35.41% had at least one emergency visit. Baseline disease severity did not predict the disease burden: the mean number of encounters was 3.0/year in the moderate/severe group as compared with 2.5/year in the mild group; p = 0.61. Among the, 63.5% of patients exposed to an intravenous biologic (Infliximab or Vedolizumab), those exposed earlier (<3 months after diagnosis) used more health care services (mean = 3.3/year) than those exposed later (mean = 2.23/year); p <0.0001. In addition, the median (IQR) cumulative days of healthcare utilisation (missing school days) for patients treated with intravenous biologics was 48.5(32.4–67.9) days during paediatric care. Conclusion Adolescents with IBD have several healthcare encounters between the diagnosis and transfer to adult care. Disease severity at diagnosis was not related to a higher level of health services utilisation during follow-up. However, treatment with intravenous biologics was associated with a high health service utilisation and school missing during follow-up.
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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 | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".