EVALUATING THE IMPACT OF THE SASKATCHEWAN INTEGRATED CARE FOR INFLAMMATORY BOWEL DISEASE ON DIRECT HEALTHCARE COSTS AND QUALITY OF LIFE
Bibliographic record
Abstract
Integrated models of care (IMC) for inflammatory bowel disease (IBD) are an emerging approach to disease management that aim to provide a holistic patient-centered care while fostering collaboration among various health professionals. Evidence shows that IMC for other chronic conditions can improve health outcomes, increase patients’ satisfaction with care, and reduce costs of care. However, to this day no research has assessed the impact of IMC for IBD on direct healthcare costs. Similarly, the impact of IMC for IBD on health-related quality of life (HRQoL) has not been previously studied, and comparative assessments of the responsiveness of generic and IBD-specific HRQoL for IBD are non-existent. This study aimed to assess the impact of exposure to an IMC for IBD on direct healthcare costs and to perform a comparative evaluation of HRQoL questionnaires. I used administrative health data from Saskatchewan, Canada, to conduct a quasi-experimental population-based study. I included individuals 18 years and older meeting a validated administrative IBD case definition. IBD cases were classified as exposed or non‐exposed to the Saskatchewan IMC. Difference in difference (DID) estimators were calculated to assess the impact of exposure to IMC on direct health care costs for IBD. We found that exposure to an IMC for IBD was associated with significantly higher overall direct healthcare costs, largely driven by the costs of biologic medications. Individuals exposed to the IMC cost the system an average $1,706.5 (95% CI 468 to 3102) more than the non-exposed. A second study using longitudinal data of a cohort of patients recently diagnosed with IBD performed a characterization of HRQoL questionnaires, as well as a comparative evaluation of their responsiveness. Individuals aged 18 years and older recently diagnosed with IBD and seen at an IMC for IBD in Saskatoon, Canada, were enrolled in the cohort. Study participants had a baseline evaluation and follow-up visits that included the assessment of HRQoL through self-administered questionnaires. I observed a trend characterized by scores denoting a better HRQoL across all the questionnaires after one and two years of follow-up. Additionally, the inflammatory bowel disease questionnaire (IBDQ) was found to be in general more responsive at both the dimension specific and the overall scores than the generic questionnaires (i.e., EuroQol iv 5-dimension and the Short Form 36-item [SF-36]). The overall SF-36 score performed comparatively to the IBDQ. This study underscores the need for subsequent economic evaluations, e.g., Cost-Utility Analysis (CUA), to ascertain whether IMC for IBD is likely to result in potential long-term net cost savings. The results of this study indicate that the SF-36 might be the preferred generic HRQoL questionnaire used for calculating quality-adjusted life years in future CUA. Moreover, multicentre studies assessing the impact of IMC on HRQoL are needed.
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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 | 0.008 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.003 |
| 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".