Skip to main content

Modelling the episodes of care for iron deficiency anemia patients in a secondary-care center using continuous-time multistate Markov chain.

Almilaji, O., 2021. Modelling the episodes of care for iron deficiency anemia patients in a secondary-care center using continuous-time multistate Markov chain. Saudi journal of gastroenterology. (In Press)

Full text available as:

[img]
Preview
PDF (OPEN ACCESS ARTICLE)
SaudiJGastroenterol000-4362349_120703.pdf - Published Version
Available under License Creative Commons Attribution Non-commercial Share Alike.

957kB
[img] PDF
Modelling the episodes of care for IDA patients in a secondary.pdf - Accepted Version
Restricted to Repository staff only
Available under License Creative Commons Attribution Non-commercial Share Alike.

397kB

Official URL: https://www.saudijgastro.com/

DOI: 10.4103/sjg.sjg_387_21

Abstract

Background: Despite the high prevalence of gastro-intestinal (GI) cancer in iron deficiency anaemia (IDA), some IDA patients do not complete all the necessary GI investigations at the initial referral. As a result, existing cancers are diagnosed at a later referral with worse prognosis. The potential to detect GI cancer early depends on minimizing the delay time spent between the two consecutive referrals, where a patient did not complete investigations at the first referral, but at the second is diagnosed with positive GI cancer. This retrospective longitudinal study aims to highlight the proper methods to model these referrals. Methods: Using anonymised data of 168 episodes of care for IDA patients at an IDA clinic in secondary care setting, continuous-time multi-state Markov chain is employed to determine the transition rates between three observed states for IDA patients at the IDA clinic; “incomplete investigations”, “negative GI cancer”, and “positive GI cancer” and to estimate the delay time. Results: Once in the state of incomplete investigations, an estimated mean delay time of 3.1 years (95% CI: 1.2, 5) is spent before being diagnosed with positive GI cancer. The probability that the “positive GI diagnosis” is next after the state of “incomplete investigation” is 17% compared with 11% when it is followed the state of negative GI cancer. Defining the survival as the event of not being in the state of “positive GI cancer”, the survival rate of IDA patients with negative GI cancer is always higher than those with incomplete investigations. Finally, being diagnosed with positive GI cancer is always preceded by the prediction of being considered “very high risk” at the earlier visit. Conclusion: A baseline model was proposed to represent episodes of care for IDA patients at a secondary care centre. Preliminary results highlight the importance of completing the GI investigations especially in IDA patients who are at high risk of GI cancer and fit enough to do the investigations.

Item Type:Article
ISSN:1319-3767
Uncontrolled Keywords:Endoscopy; episodes of care; gastrointestinal cancer; iron deficiency anemia; secondary care
Group:Faculty of Health & Social Sciences
ID Code:36212
Deposited By: Unnamed user with email symplectic@symplectic
Deposited On:10 Nov 2021 12:10
Last Modified:10 Nov 2021 12:10

Downloads

Downloads per month over past year

More statistics for this item...
Repository Staff Only -