Are All Routine Spondyloarthritis Outpatient Visits Considered Useful by Rheumatologists? An Exploratory Clinical Practice Study
Bibliographic record
Abstract
OBJECTIVE: To determine (1) the proportion of routine spondyloarthritis (SpA) outpatient visits considered (un)necessary by rheumatologists, (2) characteristics of (un)necessary visits, and (3) whether previsit remote health outcome assessments can identify the necessity of ensuing visits. METHODS: A random sample of follow-up visits was evaluated at an SpA outpatient clinic. Before visits, patient-reported outcomes and disease activity were collected through an online health registry (SpA-Net). Rheumatologists were asked whether visits were considered necessary and whether therapy was altered. Clinical actions during visits were documented alongside demographic and clinical patient characteristics; these were compared for necessary vs unnecessary visits. Multivariable logistic regressions explored which previsit health outcomes (disease activity, patient-reported physical and mental health) were associated with the perceived necessity of visits. Predictive value was calculated for high disease activity thresholds of Ankylosing Spondylitis Disease Activity Score (ASDAS) and patient global assessment (PtGA). RESULTS: Of 114 outpatient visits, 39 (34.2%) were considered unnecessary. These visits involved fewer treatment changes (6 of 39 [15.4%] vs 39 of 75 [52.0%] visits) and clinical actions (9 of 39 [23.1%] vs 47 of 75 [62.7%] visits) compared to visits considered necessary. Previsit ASDAS (OR 4.06, 95% CI 1.80-9.17) and PtGA (OR 1.65, 95% CI 1.25-2.17) were associated with the perceived necessity of visits. Positive predictive value of ASDAS ≥ 2.1 and PtGA ≥ 3.0 were 91.7% and 80.0%, respectively. CONCLUSION: Traditional physician-initiated follow-up for patients with SpA likely results in a suboptimal use of time and resources. Remote disease activity assessments can help identify patients for whom visits might be necessary from a rheumatologist's perspective.
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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 | 0.003 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".