Ignacio Marín-Jiménez1, Pilar Nos2, Eugeni Domènech3, Sabino Riestra4, Javier P Gisbert5, Xavier Calvet6, Xavier Cortés7, Eva Iglesias8, Jose M Huguet9, Carlos Taxonera10, Ramón Fernández11, Daniel Carpio12, Ana Gutiérrez13, Jordi Guardiola14, Luisa Castro Laria15, Beatriz Sicilia16, Luis Bujanda17, Luis Cea-Calvo18, Cristina Romero18, Óscar Rincón18, Berta Juliá18, Julián Panés19. 1. Gastroenterology Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain. 2. Department of Gastroenterology, La Fe University and Polytechnic Hospital, Valencia, Spain. 3. Gastroenterology Unit, Hospital Universitari Germans Trias i Pujol (Badalona), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain. 4. Department of Gastroenterology, Inflammatory Bowel Disease Unit, Central University Hospital of Asturias, Oviedo, Spain. 5. Gastroenterology Unit, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y digestivas (CIBERehd), Madrid, Spain. 6. Gastroenterology Unit, Hospital de Sabadell e Institut Universitari Parc Tauli, Sabadell, Spain. 7. Gastroenterology Unit, Hospital de Sagunto, Valencia, Spain. 8. Department of Gastroenterology, Hospital Universitario Reina Sofia, Córdoba, Spain. 9. Hospital General Universitario de Valencia, Valencia, Spain. 10. Gastroenterology Unit, Hospital Clínico San Carlos, Madrid, Spain. 11. Gastroenterology Unit, Hospital General de Jaén, Jaén, Spain. 12. IBD Unit, Complexo Hospitalario de Pontevedra, Pontevedra, Spain. 13. Gastroenterology Unit, Hospital General Universitario Alicante, Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Alicante, Spain. 14. Gastroenterology Unit Hospital de Bellvitge, Idibell, Barcelona, Spain. 15. Gastroenterology Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain. 16. Gastroenterology Unit, Hospital General de Burgos, Burgos, Spain. 17. Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain. 18. Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid, Spain. 19. Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
Abstract
OBJECTIVES: New e-health technologies can improve patient-physician communication and contribute to optimal patient care. We compared the diagnostic performance of the Simple Clinical Colitis Activity Index (SCCAI) self-administered by patients with ulcerative colitis (UC) at home (through a website) with the in-clinic gastroenterologist-assessed SCCAI. METHODS: Patients were followed-up over 6 months. At months 3 and 6, patients completed the SCCAI online at home; within 48 h, gastroenterologists (blinded to patients' scores) completed the in-clinic SCCAI (reference). SCCAI scores were dichotomized to remission or active disease, and SCCAI changes in disease activity from month 3 to 6 were classed as worsening, stability, or improvement. RESULTS: A total of 199 patients (median age: 38 years; 56% female) contributed with 340 pairs of questionnaires. Correlation of SCCAI scores by patients and physicians was good (Spearman's ρ=0.79), with 85% agreement for remission or activity (95% CI: 80.8-88.6, κ=0.66). The negative predictive value for active disease was 94.5% (91.4-96.6); the positive predictive value was 68.0% (58.8-69.2). Agreement between patient and physician was higher in the 168 month 6 pairs than in the 172 month 3 pairs of questionnaires (89.3% (83.6-93.1) vs. 80.8% (74.2-86.0), P=0.027). CONCLUSIONS: In patients with UC, SCCAI self-administration via an online tool resulted in a high percentage of agreement with evaluation by gastroenterologists, with a remarkably high negative predictive value for disease activity. Remote monitoring of UC patients is possible and might reduce hospital visits.
OBJECTIVES: New e-health technologies can improve patient-physician communication and contribute to optimal patient care. We compared the diagnostic performance of the Simple Clinical Colitis Activity Index (SCCAI) self-administered by patients with ulcerative colitis (UC) at home (through a website) with the in-clinic gastroenterologist-assessed SCCAI. METHODS:Patients were followed-up over 6 months. At months 3 and 6, patients completed the SCCAI online at home; within 48 h, gastroenterologists (blinded to patients' scores) completed the in-clinic SCCAI (reference). SCCAI scores were dichotomized to remission or active disease, and SCCAI changes in disease activity from month 3 to 6 were classed as worsening, stability, or improvement. RESULTS: A total of 199 patients (median age: 38 years; 56% female) contributed with 340 pairs of questionnaires. Correlation of SCCAI scores by patients and physicians was good (Spearman's ρ=0.79), with 85% agreement for remission or activity (95% CI: 80.8-88.6, κ=0.66). The negative predictive value for active disease was 94.5% (91.4-96.6); the positive predictive value was 68.0% (58.8-69.2). Agreement between patient and physician was higher in the 168 month 6 pairs than in the 172 month 3 pairs of questionnaires (89.3% (83.6-93.1) vs. 80.8% (74.2-86.0), P=0.027). CONCLUSIONS: In patients with UC, SCCAI self-administration via an online tool resulted in a high percentage of agreement with evaluation by gastroenterologists, with a remarkably high negative predictive value for disease activity. Remote monitoring of UC patients is possible and might reduce hospital visits.
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