A76 CLINICAL OUTCOMES, HEALTHCARE UTILIZATION AND COSTS AVOIDED WHEN ROUTINE GASTROENTEROLOGY REFERRALS ARE MANAGED IN PRIMARY CARE SUPPORTED BY CO-DEVELOPED CLINICAL CARE PATHWAYS
Bibliographic record
Abstract
Abstract Background The demand for gastroenterology (GI) care in Canada outstrips the supply. In the Calgary Zone, a Central Access and Triage (CAT) model is used as a single point of entry for most GI referrals. In collaboration with primary care, clinical care pathways (CCP) were co-developed and implemented in CAT to support care for common GI referrals in the Primary Care Medical Home (PCMH), avoiding specialty consultation/endoscopy. Aims To evaluate the re-referral rate, health outcomes, health system utilization (emergency department (ED) visits and hospitalizations) and costs avoided for referrals managed in the PCMH. Methods A prospective observational cohort study of patient referrals declined (closed) by CAT for one of seven indications supported with CCPs: chronic abdominal pain, chronic constipation, chronic diarrhea, dyspepsia, reflux disease, Helicobacter pylori, and irritable bowel syndrome (IBS). Patient clinical records were linked to healthcare administrative databases to extract data: CAT, electronic medical records, discharge databases, and physician billing claims. The Pampalon Deprivation Index evaluated socioeconomic status and education level. Costs according to Canadian Institute for Health Information were estimated for healthcare utilization, consultation and endoscopy. Results A total of 3435 referrals were closed for 3274 patients during the study period (July 1, 2018 to May 31, 2020) with dyspepsia being the most common indication (34%). The median age was 45 years, 66% were women and 43% of higher socioeconomic status. Re-referral to GI occurred in 12% leading to 414 endoscopies performed in 348 patients, the majority were normal (93.6%). Two diagnoses of colorectal adenocarcinoma were identified: 1 originally referred for dyspepsia with subsequent colonoscopy for FIT positivity and 1 initially referred for chronic diarrhea but later presented with hematochezia. Over one year, 11% of patients visited an ED yet less than half for the same indication (42.7%, 263/616 visits) with abdominal pain, dyspepsia, and IBS as most common reasons. There were 52 patients with 68 hospitalizations, but only 24% related to GI referral (constipation and abdominal pain). Estimated total costs avoided was $(CA)2,275,344; and with estimated healthcare utilization of $1,440,281, the net costs avoided was $1,477,237. Conclusions Innovative, collaborative strategies aimed to better match supple-demand disparity and improve appropriateness of specialty GI referrals are critical to improving timely patient care. Use of CCPs to support care in the PCMH is safe and reduces costs. Continued development of such supports is important to reduce avoidable healthcare utilization. Funding Agencies Health Innovation Implementation and Spread (HIIS) Fund
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".