患者和医生在远程监测平台上评估炎症性肠病活动和负担的评分上的一致性。
Agreement between patients and physicians on scores of inflammatory bowel disease activity and burden assessed on a telemonitoring platform.
机构信息
Gastroenterology Unit, Mauriziano Hospital, Turin, Italy.
Gastroenterology Unit, ASL TO 4 Hospital, Ciriè, Italy.
出版信息
Scand J Gastroenterol. 2023 Mar;58(3):240-247. doi: 10.1080/00365521.2022.2124538. Epub 2022 Sep 23.
BACKGROUND AND AIMS
Telemonitoring is increasingly used in the management of IBD patients. We investigated the agreement between patients and physicians on scores of disease activity and burden.
METHODS
Consecutive outpatients at one IBD clinic were recruited between February and December 2021. Enrolled patients completed a questionnaire for disease activity (Harvey-Bradshaw Index [HBI] for Crohn's disease or Simple Clinical Colitis Activity Index [SCCAI] for ulcerative colitis) and a test of disease burden (Pictorial Representation of Illness and Self Measure [PRISM]). They did the tests within 5 days of an outpatient visit, working independently on IBD Tool, a new web-based telemonitoring application. Concomitantly, the senior and junior physicians who examined them completed the same tests. The agreement was tested for every pair of scores.
RESULTS
Five hundred and sixty patients (289 Crohn's disease; 271 ulcerative colitis) completed disease questionnaires on IBD Tool (in total, 742 times). By Spearman's correlation, the agreement was substantial both for HBI (rho 0.685-0.837) and SCCAI (rho 0.694-0.888) for comparisons between patients, junior and senior physicians. The agreement was moderate-to-substantial for PRISM (rho 0.406-0.725) for the same comparisons. The correlation between disease activity (HBI/SCCAI) and PRISM scores was substantial for senior (rho 0.757-0.788) or junior (rho 0.746-0.753) physicians and moderate for patients (rho 0.458-0.486). The median PRISM score difference was 2.3-1.6 points lower between patients and senior-junior physicians.
CONCLUSION
Agreement between IBD patients and physicians was substantial for disease activity and moderate for disease impact. The inclusion of disease burden scoring in telemonitoring platforms provides important information for the management of IBD patients.Study highlightsWhat IS known•Continuous response to treatments and patient-reported outcomes became an essential goal for IBD patient management.•The use of tele-monitoring and eHealth technologies allows for regular disease assessments and for managing more efficiently IBD patients; disease questionnaires and tests are key to support eHealth tools.What is new here•Agreement between IBD patients and physicians was substantial for disease activity and moderate for disease burden, while agreement among junior and senior physicians was substantial for both.•PRISM performs as well for ulcerative colitis as for Crohn's patients.•The inclusion of disease burden tests might add to eHealth platforms valuable information, complemental to disease activity questionnaires.
背景与目的
远程监测在 IBD 患者管理中应用日益广泛。我们研究了患者和医生在疾病活动和负担评分上的一致性。
方法
2021 年 2 月至 12 月,连续招募了一家 IBD 诊所的门诊患者。纳入的患者完成了疾病活动问卷(克罗恩病用 Harvey-Bradshaw 指数[HBI],溃疡性结肠炎用简单临床结肠炎活动指数[SCCAI])和疾病负担测试(疾病印象和自我测量图表[PRISM])。他们在门诊就诊后 5 天内独立使用基于网络的新远程监测应用 IBD Tool 完成测试。同时,为他们检查的高年资和低年资医生也完成了相同的测试。对每一对评分进行一致性检验。
结果
560 名患者(289 名克罗恩病,271 名溃疡性结肠炎)在 IBD Tool 上完成了疾病问卷(共 742 次)。Spearman 相关性分析显示,患者、低年资和高年资医生之间的 HBI(rho 0.685-0.837)和 SCCAI(rho 0.694-0.888)评分一致性良好。对于 PRISM(rho 0.406-0.725),同样的比较中一致性为中等至良好。对于高年资(rho 0.757-0.788)或低年资(rho 0.746-0.753)医生,疾病活动(HBI/SCCAI)和 PRISM 评分之间的相关性较高,而对于患者,相关性中等(rho 0.458-0.486)。患者与高年资-低年资医生之间的 PRISM 评分中位数差异低 2.3-1.6 分。
结论
IBD 患者和医生之间在疾病活动方面的一致性较好,在疾病影响方面的一致性为中等。远程监测平台纳入疾病负担评分可为 IBD 患者管理提供重要信息。
研究亮点
• 不断响应治疗和患者报告的结果成为 IBD 患者管理的重要目标。
• 远程监测和电子健康技术的使用允许对疾病进行定期评估,并更有效地管理 IBD 患者;疾病问卷和测试是支持电子健康工具的关键。
• IBD 患者和医生在疾病活动方面的一致性较好,在疾病负担方面的一致性为中等,而低年资和高年资医生之间在这两方面的一致性较好。
• PRISM 对溃疡性结肠炎和克罗恩病患者同样有效。
• 纳入疾病负担测试可能会为电子健康平台提供有价值的信息,补充疾病活动问卷。