Using digital monitoring during the COVID pandemic to streamline outpatient appointments

Abstract Background Demand for outpatient appointments (OPAs) for IBD often exceeds capacity, partly due to scheduled follow up of patients who are well. The TrueColours-IBD (TC-IBD) platform and Escalation of Therapy or Intervention (ETI) calculator was trialed as a tool to triage appointments during the pandemic Methods TC-IBD is a web-based programme of email prompts linked to validated disease-specific indices. The ETI calculator was created after logistic regression showed that patient-reported symptoms and quality of life could calculate the probability of therapy escalation or intervention during an OPA (Fig 1). A score ≤20 equates to ≤10% chance of escalation The ETI calculator was developed for UC, but it was also applied to CD during the pandemic, replacing the SCCAI score with HBI. From Mar-Oct 2020 the ETI calculator was used to extend 145 OPAs (87 UC, 58 CD) from 1034 ETI assessments. TC-IBD data was assessed 2-6 weeks before a scheduled OPA. Patients were eligible for OPA extension if >2 symptom (SCCAI/HBI) and 1 QoL responses (IBD Control) within 4 weeks and ETI score ≤20. Patients with extended OPAs were monitored for 3 & 6-monthly ICHOM outcomes (www.ichom.org), collected through the TC-IBD platform Results ICHOM outcomes available for 113/145 patients at 3 mo and 125/145 patients at 6 mo. There were no emergency department visits, no hospitalisations, no surgery, colon cancer or death at either time point in patients whose appointment was extended. 1 patient with UC required prednisolone (Table 1) Conclusion Routine digital monitoring of symptoms, quality of life and PROMs can safely streamline outpatient care in IBD