Background:Inflammatory Bowel Diseases (IBD) are challenging conditions to manage due to the heterogeneity of the disease, diverse treatment options, and nuances of care over a range of ages. Clinical care pathways (CCPs) developed by experts enable health care providers (HCPs) to deliver standardized, high-quality, evidence-based care. In order to remain useful and valuable, these pathways need to evolve alongside changing treatment recommendations. Standardizing IBD care is a priority of Crohn's Colitis Canada's Promoting Access and Care through Centres of Excellence (PACE) network. Aim:To describe the process of nationalizing IBD CCP's, including development, standardization, maintenance, and dissemination. Methods:This project was based on a previously developed structured framework for review and maintenance. The CCP team consisted of a leadership group, advisory council and a working group with diverse representation from the country and areas of expertise. The work was tracked with a database with coordination completed by staff of the national organization. Results:The nationalization process lasted 14 months, with input from 23 HCPs from 14 academic and community institutions across Canada. Sixteen CCPs for IBD care were developed and approved by the CCP team. Challenges encountered included outdated guidelines, differing clinical opinions, and busy clinical schedules of the team members. Translation into French is complete. Support of Crohn's and Colitis Canada was invaluable. Conclusion:Despite anticipated challenges, 16 CCPs received approval from the advisory council and are publicly available to HCPs across Canada. Our approach to this undertaking and the lessons learned may be valuable for experts undertaking similar projects for patients with chronic diseases.

Introduction:Emerging adulthood (ages 18-25) involves significant changes, made more challenging for those with inflammatory bowel disease (IBD), especially when transitioning from pediatric to adult care. Research has focused on transition readiness, with less attention to patient-prioritized outcomes after transfer. Less is also known about those diagnosed during emerging adulthood, who must navigate a new diagnosis and disease management. This study estimated the prevalence of behaviors reflecting health care autonomy among emerging adults with IBD, comparing pediatric- and adult-diagnosed cases. Methods:In this cross-sectional study, emerging adults with IBD in Alberta, Canada completed a questionnaire assessing IBD knowledge, self-management, relationship with their IBD care team, and disease management. Participants were grouped as pediatric-diagnosed (<18 years) or adult-diagnosed (18-25 years). Descriptive and comparative analyses were conducted. Results:Among 178 participants (122 pediatric-diagnosed; 56 adult-diagnosed), pediatric-diagnosed cases were younger on average than adult-diagnosed cases (21.0 vs. 22.2 years), with similar distributions of gender, ethnicity and disease type. IBD knowledge scores, relationship ratings, and medication adherence scores were similar between groups. Pediatric-diagnosed cases were less independent than adult-diagnosed cases in some self-management tasks, including scheduling visits (72.6% vs. 92.9%), contacting their care team (76.0% vs. 94.6%), calling in medication refills (75.5% vs. 90.7%), and preparing questions for providers (63.3% vs. 79.3%). Conclusion:Pediatric-diagnosed cases demonstrated similar IBD knowledge, medication adherence, and satisfaction with their care team, but were less independent in some self-management tasks compared to adult-diagnosed cases. These findings highlight the need for targeted education and support for emerging adults with IBD.

The role of diet in the management of inflammatory bowel disease (IBD) is increasingly recognized with recent guidelines providing specific dietary recommendations. Although mobile health apps targeting diet and lifestyle habits in IBD are emerging, few are designed for self-management or have been formally evaluated for effectiveness. We have co-designed a diet guidance and tracking app (MyIBDDiet) with and for patients with IBD with the aim of improving overall diet profile. We will be conducting a 60-day single-centre pilot randomized trial of 40 IBD patients randomized in 1:1 ratio to MyIBDDiet app or usual care. Participants in the usual care group will crossover to the MyIBDDiet app group after 30 days. Primary outcome is usability assessed using a mixed method quantitative [Theoretical Framework of Acceptability (TFA), mHealth App Usability Questionnaire (MAUQ)], and qualitative approach (semi-structured interviews). Secondary outcomes include clinical efficacy evaluated by change in diet quality [Mini-EAT questionnaire, Automated Self-administered 24-Hour Dietary Assessment Tool (ASA-24), Healthy Eating Index (HEI), Mediterranean Diet Serving Score (MDSS)], changes in biomarkers of processed food intake (spot urine sodium and chloride), changes in IBD disease activity [Patient Reported Outcome (PRO2 and PRO3), C-reactive protein, fecal calprotectin], changes in quality of life [EuroQol-5 Dimension (EQ-5D), Short Inflammatory Bowel Disease Questionnaire (SIBDQ)] and safety. Exploratory outcomes include changes in fecal microbiome and serum and fecal metabolome. Additional quantitative data will be collected from the digital analytics of MyIBDDiet app. The pilot data generated will inform the design of an adequately powered randomized trial and future mobile app development and evaluation by providing a framework for evaluation of clinical effectiveness. Trial registration ClinicalTrials.gov Identifier: NCT06683105 . Registered on 8 November 2024.

Abstract Background Small bowel carcinomas (SBC) are rare, accounting for only 1% to 5% of all gastrointestinal cancers. However, patients with Crohn’s disease face a significantly elevated risk of SBC. This case report outlines a rare case of preoperatively-diagnosed jejunal adenocarcinoma in a patient with long-standing Crohn’s disease with diagnosis and surveillance through double balloon endoscopy (DBE). Aims A 41-year-old female with a 30-year history of small bowel Crohn’s disease presents to the hospital with overt obscure GI bleeding. Throughout the course of her disease, she was thought to be in remission with Pentasa and 6-MP, though she had mild inflammation seen in the jejunal and neoterminal ileum visualized on magnetic resonance enterography (MRE). Subsequent oral DBE showed severe nodularity and friability throughout the jejunum with biopsies showing invasive moderately differentiated adenocarcinoma. Combined oral and rectal DBE was used to facilitate tattoo placement prior to open right hemicolectomy with jejunal resections, which was complicated by intraoperative bleed and anastomotic leak. Unusually, cross-sectional imaging with computer tomography (CT) and positron emission tomography (PET-CT) showed no GI tract enhancement or evidence of metastatic spread. Post-operatively, oral DBE found a saddle shaped deformity in the jejunum which had dysplasia on one biopsy. As a result of her complicated post-operative course, the patient is receiving regular surveillance with oral DBE every six months. Methods Balloon-assisted endoscopy (BAE) has the potential to allow for endoscopic and histopathologic examination of the entire gastrointestinal tract, which makes BAE an ideal modality for both diagnosis and surveillance in Crohn’s disease. In this particular case, DBE was able to detect a subtle jejunal lesion that was not identified on CT enterography or even a PET-CT scan, resulting in earlier detection of a small bowel adenocarcinoma that was curable with surgery. Results Currently, there is a gap in literature surrounding small bowel adenocarcinoma surveillance. This is further complicated by the lack of an established macroscopic appearance of SBC and the unknown prognostic significance of dysplasia on pathology in the context of small bowel inflammation. Further, many centres have limited access to BAE. Conclusions This case shows that it has an important, and underutilized role, in IBD management. It is currently the only methodology for visual assessment and biopsy of lesions in the mid gut. Small bowel endoscopy access should be increased in Canada with a focus on IBD patients. Development of high risk identifiers for possible small bowel carcinoma also need to be developed as part of ongoing guidelines. Funding Agencies None

The expanding portfolio of targeted therapies for ulcerative colitis (UC) suggests that a more precise approach to defining disease activity will aid clinical decision-making. This prospective study used genome-wide microarrays to characterize gene expression in biopsies from the most inflamed colon segments from patients with UC and analyzed associations between molecular changes and short-term outcomes while on standard-of-care treatment. We analyzed 141 biopsies—128 biopsies from 112 UC patients and 13 biopsies from eight inflammatory bowel disease unclassified (IBDU) patients. Endoscopic disease was associated with expression of innate immunity transcripts, e.g. complement factor B (CFB); inflammasome genes (ZBP1 and PIM2); calprotectin (S100A8 and S100A9); and inflammation-, injury-, and innate immunity-associated pathway analysis terms. A cross-validated molecular machine learning classifier trained on the endoscopic Mayo subscore predicted the endoscopic Mayo subscore with area-under-the-curve of 0.85. A molecular calprotectin transcript score showed strong associations with fecal calprotectin and the endoscopic Mayo subscore. Logistic regression models showed that molecular features (e.g. molecular classifier and molecular calprotectin scores) improved the prediction of disease progression over conventional, clinical features alone (e.g. total Mayo score, fecal calprotectin, physician global assessment). The molecular features of UC showed strong correlations with disease activity and permitted development of machine-learning predictive disease classifiers that can be applied to expanded testing in diverse cohorts.

OBJECTIVES:People with inflammatory bowel disease (IBD) suffer from relapsing and remitting symptoms of gastrointestinal upset and are at substantial risk of experiencing comorbid mental distress symptoms. We aimed to conduct a systematic review of the evidence surrounding mental health telehealth interventions for IBD patients. METHODS:We searched EMBASE, MEDLINE, CINAHL, Scopus, and PsychINFO to systematically identify studies that evaluated the feasibility and acceptability of telehealth-based psychological and mind-body interventions to treat the physical and psychosocial symptoms of IBD patients. Predefined data extraction variables included descriptions of the interventions, participation and dropout rates, and preliminary effectiveness. The data was synthesized using tabular data displayed for quantitative variables and presented as narrative summaries to allow for comparison. RESULTS:Seven studies including 313 participants met our criteria and were included in the review. All studies evaluated distinct interventions. Participation rates ranged 32.4%-75%, and drop-out rates ranged 0%-33%. Most participants reported improvements in their quality of life and mental symptoms, and high satisfaction within their interventions. The authors of all included studies concluded that their interventions were feasible. CONCLUSIONS:The evidence to support using telehealth-based psychological and mind-body interventions to support individuals with IBD is limited, but promising. Interventions were positively evaluated, strongly adhered to, and preliminary effectiveness data suggest that these interventions could improve the psychosocial well-being of people with IBD. Future research is warranted to assess the effectiveness of these interventions and to evaluate the barriers to integrating them into IBD care.

Abstract Background The natural history Crohn’s disease (CD) can be complicated by strictures. Balloon-assisted endoscopy (BAE) has significantly improved the ability to assess and treat small bowel CD, allowing for stricture dilation to improve patient symptoms and potentially delay or avoid surgery. We present a single-centre CD cohort of patients that have undergone BAE for stricture dilation. We assess procedural success, outcomes and safety, evaluate factors associated with a risk of requiring surgical management. Methods All patient who underwent BAE for CD from the period oof April 2012 to January 2024 were assessed and recorded. Within this group, we identified patients who had undergone assessment and/or dilation of structuring CD. Patient demographic and procedural details were extracted. Long-term outcomes, including requirement for repeat dilation and requirement for surgery were recorded from time initial of initial BAE as surrogates for the durability of dilation in these patients. Patients required surgery post initial BAE were compared to the non-surgical group. Results At the University of Alberta Hospital, out of 532 BAE procedures in 231 patients, 157 pt underwent 282 BAE procedures with 629 strictures dilated. In our cohort, 16 strictures were non-traversable and 3 were failed dilations. We had a > 95% successful dilation rate. One perforation occurred requiring emergent surgery (n=1). 65 pts required surgery and 92 pts were managed with dilation. and pharmacotherapy. Overall, 28/65 patients were active smokers (43.08%) in the surgical group vs. 24/92 (26.09%). Biologic use was comparable (76.9% vs 73.9%). The average minimum diameter dilated was lower 15.2 mm (+/- 0.25) vs 16.2 mm(+/- 0.16) in the surgical group. Non-traversable strictures post-dilation was higher in the surgical group (14.72% vs 9.20%). A total 65 patients undersent surgery with an average time of 32.22 months (excluding emergent/urgent surgeries) from index BAE and avg 8.79 months from most recent BAE. There was a total of 3 emergent surgeries (<24 hours from BAE to surgery, including one perforation from intraprocedural complication), 7 urgent surgeries (<30 days from BAE to surgery). Conclusion Based on this cohort, the majority of patients with CD strictures CD can be successfully managed with BAE stricture dilation, and in those requiring surgery the average time from initial BAE to surgery was 32 months. BAE stricture dilation may play an important role in preventing emergent/unplanned surgical interventions and preventing surgeries in select patients. Although this study is currently descriptive, further data analysis of this group is ongoing currently.

Ustekinumab dose escalation (DE) may be an effective strategy to recapture clinical response in patients with ulcerative colitis (UC). The aim of this study was to assess the real-world long-term effectiveness and safety outcomes following ustekinumab DE in patients with moderate-to-severe UC. This multicenter retrospective cohort study included patients with moderate-to-severe UC who received at least one IV induction ustekinumab dose between January 2016 and November 2021. We compared ustekinumab DE to no DE, examining clinical, biochemical, and endoscopic disease outcomes. The primary endpoint was corticosteroid-free clinical remission (partial Mayo score ≤ 2 without systemic corticosteroids) at the end of follow-up. Cox proportional hazards regression analysis was performed for factors associated with time to DE, and a Kaplan–Meier plot was created for visualizing drug persistence probabilities. We enrolled 121 patients. Eighty-one patients (67

Background:The transition from pediatric to adult health care marks a complex and pivotal process for adolescents and young adults with inflammatory bowel disease (IBD). This group requires support regarding disease self-management, skill development, and system navigation in preparation for transition. Evidence-based interventions are needed to promote optimal health and psychosocial outcomes for adolescents and young adults with IBD during this period. Objective:A qualitative study embedded within a randomized controlled trial was conducted to evaluate the perceived impact of a biopsychosocial transition intervention on the transition experiences of adolescents and young adults, their views on the intervention, and recommendations for future care. Methods:This patient-oriented research study used a qualitative descriptive design. Virtual semistructured interviews were held with 21 adolescents and young adults with IBD (16-18 y) enrolled in the randomized controlled trial (intervention arm n=11 and control arm n=10). Interviews were audio-recorded, transcribed, and analyzed using an inductive approach to reflexive thematic analysis. Five members of a Youth Advisory Panel with lived experience of IBD collaborated throughout data analysis, interpretation, and the presentation of findings. Results:We constructed three themes through our analysis: (1) making meaning of transitions in care; (2) perceptions and impact of the biopsychosocial transition intervention; and (3) considerations for future transition care, including the importance of individualized support. Conclusions:Our findings illustrate the importance of relationships and the impact of a biopsychosocial intervention on adolescents' and young adults' confidence, knowledge, and self-management skills during transition. The results, which indicate the criticality of tailoring transition supports according to adolescents' and young adults' preferences and characteristics, will be used to refine the biopsychosocial intervention before it can be scaled and spread.

Abstract Background Inflammatory bowel disease (IBD) outreach monitoring has been shown to be cost-effective and reduce healthcare utilization. IBD STRIDE-II guidelines recommend monitoring patient-reported outcomes (PRO’s), biomarkers (e.g., fecal calprotectin (FCP), C-reactive protein (CRP)), and endoscopy to determine if patients achieve defined therapeutic targets. Previous monitoring in the literature has focused on PRO’s alone, which risks undertreating asymptomatic inflammation in spite of elevated flare and colorectal cancer risk. We designed a protocol to closely monitor biomarkers and PRO’s. Aims We aimed to assess STRIDE-II based clinical response and facilitate responsive disease management for new advanced therapy start patients. Methods Patients complete 24 weeks of outreach monitoring. PRO’s are obtained on days 0, 3, and 7, and every 2 weeks thereafter. Serum labs are collected at baseline and weeks 4, 8, 12, 16, and 24. FCP is collected at baseline and weeks 8, 16, and 24. Medication adherence is assessed at baseline and weeks 12 and 24. Endoscopy is booked 6-12 months from the start date. Treating gastroenterologists receive granular clinical reports summarizing results, the date of last IBD review, and last flare. Results 75 protocol patients on the following therapies: ustekinumab (n = 31), risankizumab (n = 17), tofacitinib (n = 14), upadacitinib (n = 10), vedolizumab (n = 2), and infliximab (n = 1) were monitored in our protocol so far. 51 patients (68.0%) had failed 1+ prior advanced therapies and 13 (17.3%) had prior IBD surgery. 7 (9.3%) were switched from their initial agent before 24 weeks due to lack of response. 1 (1.3%) had an adverse drug event. 64 patients (85.3%) complied with all FCP collections and 73 (97.3%) completed 95+% of PRO’s. Per STRIDE-II definitions, 47 patients (62.7%) demonstrated clinical response during the protocol and 25 (33.3%) achieved remission by 24 weeks. 15 (20.0%) received steroid courses, 9 (12.0%) presented to an emergency department, and 5 (6.7%) were hospitalized for IBD during monitoring. Conclusions Our proactive monitoring protocol provided granular real-world clinical response data to treating physicians. Patients were highly compliant with serial PRO, FCP, and serum labs collection. The protocol facilitates responsive disease management and may lead to treatment-specific monitoring recommendations. In future, we will compare protocol patients to standard of care managed patients to learn if the protocol reduces healthcare utilization and improves patient outcomes and quality of life. Funding Agencies None

Background Budesonide MMX is a locally acting corticosteroid with reduced side effects compared to prednisone. During the pandemic, budesonide MMX may have been preferred due to its favourable side effect profile. Aims To analyze rates of budesonide MMX dispensing and treatment failure before / during the pandemic. Methods We analyzed population-based administrative healthcare data from Alberta to identify people dispensed budesonide MMX who met three criteria: 1. incident cases of ulcerative colitis (UC) after January 1, 2018; 2. ≥18 years old; 3. not concurrently on prednisone. We defined failure of budesonide MMX as subsequent prednisone dispensing within 30 days. We calculated rates of budesonide MMX dispensing per 1000 incident UC cases. We calculated average monthly percentage change (AMPC) in dispensing and failure rates with 95% confidence intervals (CI) by Poisson or negative binomial models. An interaction term tested differences between pre-pandemic rates (prior to April 2020) and pandemic rates (April 2020 to March 2023). We used Cox proportional hazard models to compare budesonide MMX failure before vs during the pandemic, with hazard ratios (HR) and 95%CIs—a sensitivity analysis was done to extend the follow-up time to 90 days. Results Overall, 320 incident UC cases were dispensed budesonide MMX with 30-days follow-up. Of those, 14.06% (95%CI: 10.25, 17.87) received prednisone within 30 days. Mean time to failure was 17 days. There was a significant difference in the AMPC in dispensing rates was observed pre-pandemic vs during the pandemic (p=0.037) (Table 1). After the pandemic onset, budesonide MMX dispensing significantly decreased (AAPC: −2.43%; 95%CI: −3.77, −1.08). For the 30 days, the HR for budesonide MMX failure was 1.92 (95%CI: 0.95, 3.88). When the follow-up was extended to 90 days the HR was significant at 1.68 (95%CI: 1.05, 2.71), suggesting a significantly increased hazard of budesonide MMX failure during the pandemic compared to pre-pandemic. Conclusions Budesonide MMX dispensing was stable pre-pandemic but significantly decreased during. The pandemic may have been associated with an increased failure rate of budesonide MMX—particularly within 90 days—as more patients required prednisone to manage their UC. Analysis of Rates per 1000 Individuals with Incident UC Funding Agencies Ferring Pharmaceuticals

Background Evaluating small bowel Crohn’s disease (SBCD) often relies on cross-sectional imaging (eg, computed tomography enterography [CTE]) and small bowel endoscopy (eg, balloon-assisted enteroscopy [BAE]). The accuracy of CTE for evaluating SBCD compared to BAE remains unclear and is assessed in this study. Methods This single-centre retrospective study included patients with SBCD who underwent both CTE and BAE within 6 months. Findings of active inflammation, long-segment disease, skip-segments, and presence of both strictures and high-grade strictures (HGS) were extracted from CTE and BAE reports and analyzed using BAE as the reference standard. Results Sixty-three CTE and BAE pairings were identified. CTE was sensitive for assessing active inflammation (80.0%) and all strictures (92.1%) and specific for long-segment inflammation (95.0%) and HGS (87.2%). Sensitivity was low for HGS (60.9%) and long-segment inflammation (50.0%), with poor specificity for all strictures (68.4%). In surgically naïve bowel, accuracy improved for active inflammation (sensitivity: 83.3%, specificity: 100%) and worsened for HGS (sensitivity: 42.9%, specificity: 84.2%). In postsurgical bowel, CTE sensitivity for HGS improved to 68.8%. Conclusion Computed tomography enterography accurately detected active inflammation and fibrostenotic disease but may not be sufficient to rule out clinically significant findings such as HGS. The accuracy of CTE varied between surgically naïve and postsurgical bowel. CTE remains an important modality for evaluation of SBCD and should be used in combination with BAE when clinical discrepancy arises.

Background Admission rates for patients with ulcerative colitis (UC) are decreasing, however patients admitted with a UC flare are at increased risk of colectomy. In recent years, numerous advanced therapies have emerged to treat flares and maintain remission. Many patients are now “bio-experienced”, defined as prior/current exposure to at least one advanced therapy. In flare management, colectomy is reserved for patients with severe or refractory disease, or to manage complications such as toxic megacolon or perforation. It is not known if a patient’s bio-exposure status (i.e. bio-experienced or bio-naive) affects their risk of requiring a colectomy when they are hospitalized for a UC flare. Such information is important to clinicians when choosing to initiate therapy, determining the timing of therapy escalation and allowing patients to understand their risk to make informed treatment decisions. Aims To assess the relative risk of 90-day colectomy in bio-experienced versus bio-naïve patients admitted to hospital with UC flare as well as secondary outcomes such as time to first advanced therapy in hospital and length of stay (LOS). Methods This is a single centre retrospective cohort study that included patients admitted with a diagnosis of UC flare to a major tertiary hospital in Edmonton, AB from Nov 2019 to Apr 2024. The cohort was designated as bio-naïve, having never received advanced therapies or bio-experienced, having received at least one advanced therapy prior to admission. Administrative data extraction and chart review was used to obtain the primary and secondary outcomes. Relative risk of colectomy was calculated between groups and a 95% confidence interval generated for this. The secondary outcomes were analyzed using an unpaired t-test with the significance level of p<0.05. For LOS with colectomy, given significant variance, median and IQR were reported instead. Results In total, there were 216 admissions; 87 patients were bio-experienced and 129 were bio-naïve at the time of admission. Twenty-six patients underwent colectomy within 90 days. Of the patients who were bio-experienced, 18.39% underwent colectomy compared to 7.75% in the bio-naïve group. The relative risk of 90-day colectomy in the bio-experienced compared to bio-naïve patients was 2.37 (1.13-4.98 95% CI). Secondary outcomes showed similar average length of stay, however bio-experienced patients were placed on advanced therapy sooner and those requiring colectomy had shortened LOS, compared to bio-naïve patients (Figure 1). Chart review for other secondary outcomes (eg. prior therapies, disease duration) is underway. Conclusions In this retrospective cohort study, we demonstrated that the relative risk of colectomy for UC patients admitted with flare is 2.3 fold higher in bio-experienced compared to bio-naïve patients. Figure 1 Funding Agencies None

Background:Individuals with inflammatory bowel disease (IBD) require comprehensive care to address the physical and psychosocial burden of their disease. The demand for IBD care often exceeds availability, resulting in delayed access and suboptimal management. As a result, patients with IBD are required to self-manage significant aspects of their disease between appointments with their medical team. Digital self-management tools may help address this gap by empowering patients to be more engaged in managing their disease, potentially improving outcomes and reducing the strain on the health care system. Objective:This study aimed to design, implement, and evaluate a bundled digital health tool, MyIBDToolkit, with the overarching goal of improving the quality of care and self-management for patients with IBD in Alberta, Canada. Methods:A bundled digital health tool, MyIBDToolkit, will be integrated into our provincial electronic health record system to ensure broad accessibility and continuity of care. We will use a type 2 hybrid effectiveness-implementation design to evaluate both the clinical impact and real-world integration of the toolkit. We will assess effectiveness through changes in key outcomes such as health care utilization (eg, emergency visits, hospitalizations), disease burden on patients (eg, quality of life, symptom control), and burden on the health care system. These outcomes will be measured using comprehensive health care administrative data. A dual-comparison approach will be used: a within-subject comparison of health care utilization and disease burden before and after implementation of the MyIBDToolkit, and a between-group comparison of outcomes among toolkit users versus nonusers. To evaluate implementation success, we will examine reach (ie, number of patients and providers using the tool), fidelity to the planned timeline, sustained use over time, and factors influencing adoption and maintenance. Our goal is to reach 10,000 patients across Alberta, Canada, within three years. Results:We received funding for this project in January 2023. In preparation for the pilot launch, we have identified key stakeholders, including patients, health care providers and, administrators, and developed strategies to assess their readiness for MyIBDToolkit. We are also collecting mixed-methods data from patients to explore potential barriers and facilitators to using MyIBDToolkit. The first phase of MyIBDToolkit was launched in October 2024. Conclusions:MyIBDToolkit represents a scalable and patient-centered approach to the self-management of IBD care. By empowering patients to self-manage their disease between health care visits, we aim to reduce the burden of IBD on patients, providers, and the health care system. By evaluating the effectiveness and the implementation of the MyIBDToolkit, we aim to generate actionable and sustainable improvements to IBD care in Alberta.

Background:The typical transition from pediatric to adult care in patients with inflammatory bowel disease occurs with an increase in health care utilization and a decrease in adherence to medications and scheduled appointments. An effective transition could reduce negative impacts but requires identifying opportunities to improve this process. This study aims to describe barriers and facilitators of transition according to patients, parents, and health care providers. Methods:This study used a qualitative description approach. The lead author conducted semi-structured interviews with 17 patients, 13 parents, and 15 providers recruited from Western Canada. Latent content analysis identified themes in interview transcripts. Results:The theme of preparedness emerged across all groups as a transition facilitator. Other facilitators that emerged included patient characteristics, supportive parents, home environment, and supportive adult care team. Themes of barriers that emerged included patient factors, "hovering parents" and family factors, navigating a new health care system, and travel distance. Conclusions:This study describes facilitators and barriers according to each stakeholder involved in the transition process. Future studies should focus on designing and evaluating interventions aimed at promoting facilitators and addressing identified barriers in patients preparing to transition from pediatric to adult care.

Abstract Background Competency based medical education has become the new standard for medical education which shifts the focus of training toward a competency, rather than time-based in framework known in Canada as ‘Competence by Design’ (CBD). CBD assesses a physician trainee’s ability to demonstrate competence in CanMEDS roles via entrustable professional activities (EPAs). EPAs utilize the O-SCORE as the metric for assessing competence. This score was developed and validated for surgical/procedural subspecialties; however, CBD currently coopts this scale for both procedural and non-procedural (cognitive) EPAs. Assessor expertise has also been shown to have an important role in performance assessments, but has not been studied in the context of CBD. Aims Our study aims to assess for differences in O-SCORE utilization between cognitive and procedural EPAs, and whether assessor characteristics are associated with trends in assessment. Methods Anonymized data for all Adult GI subspecialty EPAs completed from Jun 2019 to Jan 2023 at the University of Alberta was obtained. Evaluator sex, clinical vs academic practice, advanced training expertise, and EPA score was extracted. Locally a score of 5 denotes competence, while a 1-3 indicates competence was not yet achieved. A score of 4 may be accepted as evidence of competence (neutral score), at the discretion of the local competency committee. Data was analyzed via T-tests and ANOVA with post hoc Games-Howell testing with 95% confidence intervals (CI). A p-value of ampersand:003C0.05 was significant. Results 2264 EPAs were assessed including 1385 cognitive and 879 procedural EPAs. The number of EPAs completed by evaluators ranged from 11 to 165 with a mean of 60 (standard deviation: 40). Results of O-SCORE usage is summarized in Figure 1A-B. The majority of EPAs indicate competence, with 20-25% neutral, and ampersand:003C10% did not achieve competence. Less than one of third of evaluators utilized a score of 1 or 2 across all EPAs, and zero evaluators utilized a score of 1 for cognitive EPAs. Most commonly evaluators to utilized 3/5 options of the O-SCORE. Separated by EPA type, it was most common to utilize 2/5 and 4/5 options for cognitive and procedural EPAs respectively. Results of demographic comparisons are outlined if Figure 1C-E. Male and clinical evaluators submitted higher scores on average. Hepatologists submitted higher scores than all other advanced training areas for total, cognitive, and procedural EPAs. Conclusions Across total, cognitive, and procedural EPAs there are low rates in the utilization of the whole O-SCORE scale, and our study highlights a discrepancy between procedural and cognitive EPAs. In addition, there small but significant differences in the mean EPAs score awarded between different evaluator demographics (male, clinical, hepatologists providing higher scores). Figure 1. A) Number and proportion of Entrustable Professional Activities (EPA) stratified by type and competence evaluation. B) Number and proportion of Entrustable Professional Activities (EPA) stratified by type with scored 1-5 and percent (%) of staff utilizing each score stratified by EPA type C) Number, mean, and mean difference of Entrustable Professional Activities (EPA) stratified by evaluator sex and EPA type. D) Number, mean, and mean difference of Entrustable Professional Activities (EPA) stratified by evaluator academic vs clinical status and EPA type. E) Number, mean, and mean difference of Entrustable Professional Activities (EPA) stratified by evaluator advanced training and EPA type. CI: Confidence interval; SD: standard deviation; *: pampersand:003C0.05 Funding Agencies None

Abstract Background Endoscopic training within Canada occurs in programs accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC). Beyond national accreditation, there are no standardized endoscopic training curriculums and each program is responsible for ensuring its trainees achieve competency. There is debate in the literature regarding the minimum number of endoscopic procedures and the role of objective assessment tools in the assessment of trainee competence with no specific recommendations for these by the RCPSC. Aims The goal of our study was to characterize endoscopic training curriculums within Canadian training programs while determining the usage and perceived importance of procedure volume tracking and objective assessment tools. Methods Online surveys were sent to program directors (PD) and trainees within Adult Gastroenterology, Pediatric Gastroenterology, General Surgery and Colorectal Surgery programs within Canada. Surveys contained questions meant to characterize endoscopy training curriculums and perceived effectiveness of the curriculum while highlighting the factors important for feedback and competency assessment. Results Survey responses were obtained from 20 PDs and 83 trainees. Of all programs surveyed 53% (44/83) of trainees reported that they had a formal endoscopy curriculum compared with 75% (15/20) of PDs. PDs assessed endoscopic competence predominantly by EPAs (95%) and verbal feedback (65%) with minimal usage of objective tools (30%). Trainees reported fewer objective tool usage at 2.4% (2/83). When assessed on a 5-point Likert scale, both PDs and trainees felt that verbal feedback was the most important for assessment of competence (3.58 and 4.39 respectively). Seventy-seven percent of trainees report using a procedure log and when asked about procedure volume 37% of trainees expected to complete ampersand:003C250 colonoscopies by the end of their training. Eighty-three percent of PDs felt that all their trainees achieved endoscopic competency with only 50% of adult GI PDs reporting the same. Most PDs and trainees felt that national recommendations for objective tool usage (65% and 57% respectively) and minimum procedure volume (65% and 63% respectively) would be helpful to standardize endoscopic training. Additional results are reported in Figure 1. Conclusions Most training programs reported a standardized curriculum with a majority of trainees tracking their procedure volume, but a minority of programs incorporated objective tools. A significant portion of trainees expected to complete ampersand:003C250 colonoscopies by the end of their training and not all PDs felt that all of their trainees reach endoscopic competence. The majority of trainees and PDs felt national recommendations for procedure tracking and objective tools would be helpful, suggesting the need for more formalized endoscopic curriculums in Canada. Funding Agencies None