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Intervention (Biologic care pathway) was implemented outside of the context of a research study at our care centre, the QEII, as quality improvement. It became infeasible to consent all physicians to use the tool, and carry out this study.
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| Name | Class |
|---|---|
| Nova Scotia Health Authority | OTHER |
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Inflammatory Bowel Disease (IBD) includes a group of chronic inflammatory conditions of the gastrointestinal system and is composed of Crohn's disease and ulcerative colitis. As an immune-mediated disease, IBD treatment options include the use of biologic medicines including anti-tumor necrosis alpha factor (also called anti-TNFs) medication. Despite biologic medicines being an important part of IBD management, there is inconsistency in the way these medications are used. Implementation of evidence-based, standardized biologic care pathways (BCP) can improve treatment related outcomes. Previous research has shown that using a clinical care pathway, such as a BCP, is a feasible method to support clinical decision making and may improve disease-related outcomes for patients. The researchers propose a prospective study to determine how well a BCP can be incorporated into clinical practice, improve patient health outcomes, and reduce healthcare system redundancies. Also, the impact of a BCP on outcomes for patients treated with the help of a standardized BCP compared to those in patients treated without the use of a BCP will be studied. The results of this study will inform how best to incorporate evidence-based BCPs into real-world practice and support the wide-spread adoption of BCPs in clinical practice.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Biologic Care Pathway | Experimental | Care through a biologic care pathway |
|
| Control | No Intervention | Care as usual |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Biologic Care Pathway | Other | Receiving care administered through a biologic care pathway.The central biologic intake nurse will touch base with the IBD program nurse navigator at preselected time points as per the pathway in order to coordinate the baseline pre- biologic work-up, clinical and biomarker assessments, and clinical assessments. Clinical management decisions will be informed by a combination of data points including clinical risk factors, TDM, fecal calprotectin concentrations, endoscopic and clinical disease activity indices as well as drug tolerance and adverse events. Within the care pathway, time- bound clinical and biomarker data will be provided to the treating clinician to help inform their clinical decisions. |
| Measure | Description | Time Frame |
|---|---|---|
| EQ5D Score | General Quality of life data measured using the Euroqol five dimension (EQ5D) Questionnaire. The EQ5D is a brief self-reported generic measure of current health. It is a 2 page questionnaire which has 5 descriptive questions. Each question may have 1 of 3-level answers, and a visual analog scale (VAS) on which patients can mark their current health state. The EQ-5D-3L index is calculated by subtracting the values of the descriptive EQ-5D system from the numerical value 1. This corresponds to the best possible health status, while an index value of <0 represents the worst possible health status. | week 0 (baseline) |
| EQ5D Score | General Quality of life data measured using the Euroqol five dimension (EQ5D) Questionnaire. The EQ5D is a brief self-reported generic measure of current health. It is a 2 page questionnaire which has 5 descriptive questions. Each question may have 1 of 3-level answers, and a visual analog scale (VAS) on which patients can mark their current health state. The EQ-5D-3L index is calculated by subtracting the values of the descriptive EQ-5D system from the numerical value 1. This corresponds to the best possible health status, while an index value of <0 represents the worst possible health status. | week 50 |
| Measure | Description | Time Frame |
|---|---|---|
| Emergency room visits | Number of emergency room visits | week 0 (baseline) |
| Emergency room visits | Number of emergency room visits | month 12 |
| Measure | Description | Time Frame |
|---|---|---|
| HBI Index Score | IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are potential final score results: Remission: <5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: >16 | week 0 (baseline), week 12-14, week 30, week 50 |
Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| QEII Health Sciences Centre | Halifax | Nova Scotia | B3H 2Y9 | Canada |
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| ID | Term |
|---|---|
| D015212 | Inflammatory Bowel Diseases |
| D003093 | Colitis, Ulcerative |
| D003424 | Crohn Disease |
| ID | Term |
|---|---|
| D005759 | Gastroenteritis |
| D005767 | Gastrointestinal Diseases |
| D004066 | Digestive System Diseases |
| D007410 | Intestinal Diseases |
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| inpatient hospitalization, | Number of inpatient hospitalizations | week 0 |
| inpatient hospitalization, | Number of inpatient hospitalizations | month 12 |
| disease-related surgery | Number of disease related surgeries | week 0 |
| disease-related surgery | Number of disease related surgeries | month 12 |
| ambulatory care visits | number of ambulatory care visits | week 0 |
| ambulatory care visits | number of ambulatory care visits | month 12 |
| drug therapy | A list of current medications the patient is taking | week 0 |
| drug therapy | A list of current medications the patient is taking | month 12 |
| HBI Index Score | IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are potential final score results: Remission: <5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: >16 | week 0 (baseline) |
| HBI Index Score | IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are potential final score results: Remission: <5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: >16 | week 12 |
| HBI Index Score | IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are potential final score results: Remission: <5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: >16 | week 30 |
| HBI Index Score | IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are strata for final score results: Remission: <5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: >16 | week 50 |
| Partial Mayo Score | IBD disease activity (as measured by the Partial Mayo Score). Partial Mayo Score measures disease activity of Ulcerative colitis. The following are strata for final score results: Total Partial Mayo Index Score Remission: 0-1 Mild Disease: 2-4 Moderate Disease: 5-6 Severe Disease: 7-9 | week 0 (baseline) |
| Partial Mayo Score | IBD disease activity (as measured by the Partial Mayo Score). Partial Mayo Score measures disease activity of Ulcerative colitis. The following are strata for final score results: Total Partial Mayo Index Score Remission: 0-1 Mild Disease: 2-4 Moderate Disease: 5-6 Severe Disease: 7-9 | week 12 |
| Partial Mayo Score | IBD disease activity (as measured by the Partial Mayo Score). Partial Mayo Score measures disease activity of Ulcerative colitis. The following are strata for final score results: Total Partial Mayo Index Score Remission: 0-1 Mild Disease: 2-4 Moderate Disease: 5-6 Severe Disease: 7-9 | week 30 |
| Partial Mayo Score | IBD disease activity (as measured by the Partial Mayo Score). Partial Mayo Score measures disease activity of Ulcerative colitis. The following are strata for final score results: Total Partial Mayo Index Score Remission: 0-1 Mild Disease: 2-4 Moderate Disease: 5-6 Severe Disease: 7-9 | week 50 |
| Fecal calprotectin | Fecal calprotectin concentration, assayed by stool sample | week 0 (baseline) |
| Fecal calprotectin | Fecal calprotectin concentration, assayed by stool sample | week 12 |
| Fecal calprotectin | Fecal calprotectin concentration, assayed by stool sample | week 30 |
| Fecal calprotectin | Fecal calprotectin concentration, assayed by stool sample | week 50 |
| CRP concentration | serum CRP concentration | week 0 (baseline) |
| CRP concentration | serum CRP concentration | week 12 |
| CRP concentration | serum CRP concentration | week 30 |
| CRP concentration | serum CRP concentration | week 50 |
| D003092 | Colitis |
| D003108 | Colonic Diseases |