Development of the Escalation of Therapy or Intervention (ETI) calculator for patients with ulcerative colitis using ePROMS.
Matini L., Chapman TP., Kantschuster R., Wilson J., Tarafdar A., Hussain M., Song K., Simadibrata DM., Seeva P., White L., Slater J., Kormilitzin A., IBD Cohort Investigators None., Collins G., Travis SPL., Walsh A.
BACKGROUND AND AIMS: Digital collection of patient reported outcome measures (PROMs) is largely unexplored as a basis for follow up for patients with ulcerative colitis (UC). Our aim was to develop a model to predict the likelihood of escalation of therapy or intervention at an outpatient appointment that may be used to rationalise follow up. METHODS: TrueColours-IBD is web-based, real-time, remote monitoring software that allows longitudinal collection of ePROMs. Data for prediction modelling were derived from a Development Cohort, guided by the TRIPOD statement. Logistic regression modelling used 10 candidate items to predict escalation of therapy or intervention. An Escalation of Therapy and Intervention (ETI) calculator was developed. and applied in a Validation Cohort at the same centre. RESULTS: The Development Cohort (n=66) was recruited in 2016 and followed for six months (208 appointments). From 10 items, four significant predictors of ETI were identified: SCCAI, IBD Control-8, faecal calprotectin and platelets. For practicality, a model with only SCCAI and IBD Control-8, both entered remotely by the patient, without the need for faecal calprotectin or blood tests was selected. Between 2018 and 2020, a Validation Cohort of 538 patients (1188 appointments) was examined. A 5% threshold on the ETI calculator correctly identified 343/388 (88%) escalations and 274/484 (57%) non-escalations. CONCLUSIONS: A calculator based on digital, patient-entered data on symptoms and QoL can predict whether a patient with UC requires escalation of therapy or intervention at an outpatient appointment. This may be used to streamline outpatient appointments for patients with UC.