Concordance and Discordance Between Patient-reported Remission, Patient-reported Outcomes, and Physician Global Assessment.

BACKGROUND: Although validated patient-reported outcome (PRO) measurements can categorize patients with inflammatory bowel disease (IBD) into clinical remission or active disease, patients may have different definitions of remission. The purpose of this study was to compare patient-defined remission to remission based on PRO measures and physician global assessment (PGA) and to understand the clinical and demographic factors associated with disagreements. METHODS: We retrospectively analyzed 3257 de-identified surveys from 2004 IBD patients who consented to participate in the Crohn's and Colitis Foundation's IBD Qorus Learning Health System between September 2019 and February 2021. We used logistic regression models with generalized estimating equations to analyze the clinical and demographic factors (eg, age, disease duration, health confidence) associated with discordance between patient-defined remission (yes/no) and PRO-defined remission for ulcerative colitis (UC; PRO2: stool frequency, rectal bleeding) and Crohn's disease (CD; PRO-3: average number of liquid stools, abdominal pain, well-being). RESULTS: Among patients with UC, overall concordance was 79% between patient self-report and PRO2-defined remission and 49% between patient self-report and PGA-defined remission. Among patients with CD, overall concordance was 69% between patient self-report and PRO3-defined remission and 54% between patient self-report and PGA-defined remission. Patients in PRO-defined remission were more likely to report active disease if they had IBD <5 years and low health confidence. Patients with PRO-defined active disease were more likely to report remission if they were not using prednisone and had high health confidence. CONCLUSION: Discordance exists between how remission is defined by patients, PRO measures, and PGA.

Discordance between patients' self-reported remission and remission defined based on patient-reported outcomes was observed in 31% of Crohn's disease visits and 21% of ulcerative colitis visits. Disease duration and health confidence were associated with discordance.

Changes in Medicare Reimbursement for Common Gastroenterology Services Over 15 Years: 2007-2022.

INTRODUCTION: We evaluated trends in Medicare reimbursement for common gastrointestinal (GI) services from 2007 to 2022. METHODS: Top GI procedures and office/inpatient visits were identified. The Physician Fee Schedule Look-Up Tool from Centers for Medicare & Medicaid Services was queried to extract reimbursement data. Reimbursement trends were analyzed, accounting for inflation. RESULTS: GI procedures exhibited an average decrease in unadjusted and adjusted reimbursement of 7.0% and 33.0%, respectively. Reimbursement for patient visits exhibited an inflation-adjusted decrease of 4.9%. DISCUSSION: The analysis revealed a steady decline in adjusted reimbursement for both GI procedures and patient visits in the past 15 years.

Highly Accurate Step Counting at Various Walking States Using Low-Cost Inertial Measurement Unit Support Indoor Positioning System.

Accurate step counting is essential for indoor positioning, health monitoring systems, and other indoor positioning services. There are several publications and commercial applications in step counting. Nevertheless, over-counting, under-counting, and false walking problems are still encountered in these methods. In this paper, we propose to develop a highly accurate step counting method to solve these limitations by proposing four features: Minimal peak distance, minimal peak prominence, dynamic thresholding, and vibration elimination, and these features are adaptive with the user's states. Our proposed features are combined with periodicity and similarity features to solve false walking problem. The proposed method shows a significant improvement of 99.42% and 96.47% of the average of accuracy in free walking and false walking problems, respectively, on our datasets. Furthermore, our proposed method also achieves the average accuracy of 97.04% on public datasets and better accuracy in comparison with three commercial step counting applications: Pedometer and Weight Loss Coach installed on Lenovo P780, Health apps in iPhone 5s (iOS 10.3.3), and S-health in Samsung Galaxy S5 (Android 6.01).