P1600 - Automated Clinical Pathway Utilizing Custom Risk Stratification Identifies Substantial Rates of Overdue Follow up and Facilitates Population Health Interventions

Award: Presidential Poster Award

Award: Presidential Poster Award

Matthew K. Schroeder, MD, Sean Tan, , David Fudman, MD
University of Texas Southwestern Medical Center, Dallas, TX

Introduction: Inflammatory bowel disease (IBD) is a lifelong condition that requires proactive and comprehensive outpatient management for adequate disease control. This necessitates consistent follow up for monitoring of symptoms, objective markers of disease activity, drug safety, and disease-specific health maintenance.

Methods: We identified patients with IBD followed in a tertiary care subspeciality clinic using SNOMED CT terminology for Crohn’s disease (CD) and ulcerative colitis (UC) within either the active problem list or visit diagnosis, a clinical visit in the last three years, and at least one IBD-specific medication. These patients were enrolled into a novel clinical pathway integrated into the electronic medical record (Epic Hyperspace) which identified patients overdue for follow-up based on their risk stratification (Figure 1). Initial risk stratification was automated within the pathway according to medication use: patients with a prednisone prescription in the last 90 days were classified as high risk; those utilizing biologics, immunomodulators, or small molecule therapy were classified as medium risk; those not utilizing these therapies were classified as low risk. Overdue follow up was defined at 3-, 6-, and 12-month intervals for high, medium, and low risk groups, respectively. At each visit, the clinicians are given the opportunity to re-classify each patient’s risk category based on their personalized assessment.

Results: We identified 925 patients with IBD who were initially included on the clinical pathway. Patients were median age of 44 years, 55.8% female, 69.5% Caucasian, and 58.3% with diagnosis of CD. Within this population, 65.5% were managed with biologics or tofacitinib, 17.5% with immunomodulators, and 33.3% with aminosalicylates. At time of inclusion, patients had followed in our clinic for a median of 4.2 years with a median of 84 days since last clinic visit. Using the clinical pathway, 191 (20.6%) patients were overdue for follow up. Within each group, 35 (28.4%) high risk, 102 (16.5%) medium risk, and 54 (29.5%) low risk patients were overdue for follow up.

Discussion: We identified a large proportion of patients overdue for follow up using a clinical pathway integrated into the electronic medical record. This tool can be used to develop targeted interventions to improve rates of on-time clinical follow up. Additionally, the care pathway can be expanded to include population-level monitoring of drug safety, inflammatory assessments, and health maintenance goals.


Figure: Figure 1: Automated clinical pathway for follow up monitoring of patients with inflammatory bowel disease

	Total (n = 925)	On-Time (n = 734)	Overdue (n = 191)
Age, median, y	44	44	49
Female sex, n (%)	516 (55.8%)	409 (55.7%)	107 (56%)
Caucasian, n (%)	643 (69.5%)	515 (70.2%)	128 (67%)
Crohn's disease, n (%)*	539 (58.3%)	435 (59.3%)	104 (54.5%)
Ulcerative colitis, n (%)*	473 (51.1%)	370 (50.4%)	103 (53.9%)
Biologic/tofacitinib, n (%)	606 (65.5%)	509 (69.3%)	97 (50.8%)
Immunomodulator, n (%)	162 (17.5%)	135 (18.4%)	27 (14.1%)
5ASA, n (%)	308 (33.3%)	229 (31.2%)	79 (41.4%)
Last clinic visit, median, d	84	60	319
Years in practice, median, y	4.2	4.1	4.7
Low risk, n (%)	183 (19.8%)	129 (17.8%)	54 (28.3%)
Medium risk, n (%)	619 (66.9%)	517 (70.4%)	102 (53.4%)
High risk, n (%)	123 (13.3%)	88 (12%)	35 (18.3%)

*94 (10.2%) of patient included with coded diagnosis of both Crohn's disease and ulcerative colitis

Table: Table 1: Demographics, disease characteristics, and risk stratification of patients enrolled on inflammatory bowel disease clinical pathway


Disclosures:
Matthew Schroeder indicated no relevant financial relationships.
Sean Tan indicated no relevant financial relationships.
David Fudman: Pfizer – Advisory Committee/Board Member.


Matthew K. Schroeder, MD, Sean Tan, , David Fudman, MD. P1600 - Automated Clinical Pathway Utilizing Custom Risk Stratification Identifies Substantial Rates of Overdue Follow up and Facilitates Population Health Interventions, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.