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Roberts JH, Gun C, Mackinnon JE, Parlee S, Bakowsky V, Taylor T, Barber CEH, Hanly JG. Feasibility of physiotherapist-led rheumatology triage: A randomized study. J Rheumatol 2024:jrheum.2023-1071. [PMID: 38621798 DOI: 10.3899/jrheum.2023-1071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Given global shortages in the rheumatology workforce, the demand for rheumatology assessment often exceeds the capacity to provide timely access to care. Accurate triage of patient referrals is important to ensure appropriate utilization of finite resources. We assessed the feasibility of physiotherapist-led triage utilizing a standardized protocol, in identifying cases of inflammatory arthritis (IA), as compared to usual rheumatologist triage of referrals for joint pain, in a tertiary care rheumatology clinic. METHODS We performed a single-center, prospective, non-blinded, randomized, parallel-group feasibility study with referrals randomized in a 1:1 ratio to either physiotherapist-led versus usual rheumatologist triage. Standardized information was collected at referral receipt, triage, and clinic visit. Rheumatologist diagnosis was considered the gold-standard for diagnosis of IA. RESULTS 102 referrals were randomized to the physiotherapist-led triage arm and 101 to the rheumatologist arm. In the physiotherapist-led arm, 65 percent of referrals triaged as urgent were confirmed to have IA versus 60 percent in the rheumatologist arm (p=0.57) suggesting similar accuracy in identifying IA. More referrals were declined in the physiotherapist-led triage arm 24 versus 8 (p=0.002) resulting in less referrals triaged as semi-urgent 6 versus 23 (p < 0.003). One case of IA (rheumatologist arm) was incorrectly triaged, resulting in significant delay in time to first assessment. CONCLUSION Physiotherapist-led triage was feasible, appeared as reliable as rheumatologist triage of referrals for joint pain, and lead to significantly fewer patients requiring in-clinic visits.
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Affiliation(s)
- Janet H Roberts
- JH Roberts, MD, FRCPC, Division of Rheumatology and Department of Medicine, QEII Health Sciences Centre and Dalhousie University. Arthritis Research Canada
| | - Cheri Gun
- C Gunn, BSc PT, QEII Health Sciences Centre
| | | | | | - Volodko Bakowsky
- V Bakowsky MD FRCPC, Division of Rheumatology and Department of Medicine, QEII Health Sciences Centre and Dalhousie University
| | - Trudy Taylor
- T Taylor MD FRCPC, Division of Rheumatology and Department of Medicine, QEII Health Sciences Centre and Dalhousie University
| | - Claire E H Barber
- CEH Barber MD PhD FRCPC, Department of Medicine and Department of Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - John G Hanly
- JG Hanly MD FRCPC, Division of Rheumatology and Department of Medicine, QEII Health Sciences Centre and Dalhousie University
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Décary S, de Wit M, Naye F, Barton JL, Fraenkel L, Li LC, Brooks P, Stacey D, Maxwell LJ, Campbell W, Hofstetter C, Voshaar M, Meara A, Christensen R, Boonen A, Suarez-Almazor ME, Meade T, March L, Jull JE, Alten R, Morgan EM, Stewart Hazlewood G, Barber CEH, Guillemin F, El-Miedany Y, Mittoo S, Robertson TW, Bartlett SJ, Singh JA, Mannion M, Nasef SI, Boel A, Adebajo A, Arnaud L, Gill TK, Moholt E, Burt J, Jayatilleke A, Hmamouchi I, Berthelsen DB, Blanco FJ, Mather K, Maharaj A, Sharma S, Caso F, Beaton D, Shea B, Fong C, Fernandez AP, Mackie S, Nikiphorou E, Jones A, Greer-Smith R, Sloan VS, Akpabio A, Strand V, Lee RR, Umaefulam V, Monti S, Abaza N, Schultz G, Stones S, Gossec L, Nielsen SM, Cavallo S, Srinivasalu H, Constien D, Evans V, Tugwell P, Toupin-April K. Consensus on the definitions and descriptions of the domains of the OMERACT Core Outcome Set for shared decision making interventions in rheumatology trials. Semin Arthritis Rheum 2024; 65:152381. [PMID: 38306813 DOI: 10.1016/j.semarthrit.2024.152381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/15/2023] [Accepted: 01/03/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To gain consensus on the definitions and descriptions of the domains of the Outcome Measures in Rheumatology (OMERACT) core domain set for rheumatology trials evaluating shared decision making (SDM) interventions. METHODS Following the OMERACT Handbook methods, our Working Group (WG), comprised of 90 members, including 17 patient research partners (PRPs) and 73 clinicians and researchers, had six virtual meetings in addition to email exchanges to develop draft definitions and descriptions. The WG then conducted an international survey of its members to gain consensus on the definitions and descriptions. Finally, the WG members had virtual meetings and e-mail exchanges to review survey results and finalize names, definitions and descriptions of the domains. RESULTS WG members contributed to developing the definitions. Fifty-two members representing four continents and 13 countries completed the survey, including 15 PRPs, 33 clinicians and 37 researchers. PRPs and clinicians/researchers agreed with all definitions and descriptions with agreements ranging from 87% to 100%. Respondents suggested wording changes to the names, definitions and descriptions to better reflect the domains. Discussions led to further simplification and clarification to address common questions/concerns about the domains. CONCLUSION Our WG reached consensus on the definitions and descriptions of the domains of the core domain set for rheumatology trials of SDM interventions. This step is crucial to understand each domain and provides the foundation to identify instruments to measure each domain for inclusion in the Core Outcome Measurement Set. CLINICAL SIGNIFICANCE The current study provides consensus-based definitions and descriptions for the domains of the OMERACT core domain set for shared decision making interventions from patients/caregivers, clinicians and researchers. This is a crucial step to understand each domain and provides the foundation to identify instruments to measure each domain for inclusion in the Core Outcome Measurement Set for trials of SDM interventions.
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Affiliation(s)
- Simon Décary
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Florian Naye
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | - Jennifer L Barton
- VA Portland Health Care System, Oregon Health & Science University, Portland, USA
| | - Liana Fraenkel
- Department of Internal Medicine, Yale University, New Haven, USA
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia; Arthritis Research Canada, Canada
| | - Peter Brooks
- School of Population and Global Health, University of Melbourne and Northern Health, Melbourne, Australia
| | - Dawn Stacey
- School of Nursing, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lara J Maxwell
- Centre for Practice Changing Research, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Willemina Campbell
- Patient Research Partner, Toronto Western Hospital, University Health Network, Canada
| | | | - Marieke Voshaar
- Patient Research Partner; Department of Pharmacy and Department of Research & Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Pharmacy, Radboud university medical center, Nijmegen, The Netherlands
| | - Alexa Meara
- Division of Rheumatology, The Ohio State University, Columbus, USA
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, & Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Maria E Suarez-Almazor
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Tanya Meade
- Western Sydney University, Sydney, Australia
| | - Lyn March
- Department of Rheumatology, Royal North Shore Hospital; The University of Sydney, Australia
| | | | - Rieke Alten
- Department of Internal Medicine II, Rheumatology Research Center, Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany
| | - Esi M Morgan
- Department of Pediatrics, University of Washington. Division of Rheumatology, Seattle Children's Hospital, Seattle, Washington, USA
| | | | - Claire E H Barber
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Yasser El-Miedany
- Canterbury Christ Church University, Canterbury; King's College London, London, United Kingdom
| | - Shikha Mittoo
- Vanshavardhana Canada Integrated Health, Toronto, Canada
| | - Tiffany Westrich Robertson
- CEO, Patient research partner, International Foundation for Autoimmune & Autoinflammatory Arthritis (AiArthritis), USA
| | - Susan J Bartlett
- Divisions of Clinical Epidemiology, Rheumatology and Respiratory Epidemiology and Clinical Trials Unit, McGill University; Research Institute, McGill University Health Centre; Johns Hopkins Medicine Division of Rheumatology, Montreal, Canada
| | | | - Melissa Mannion
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Samah Ismail Nasef
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Anne Boel
- Department of Rheumatology, Leiden University Medical Centre; UCB Pharma, B.V. Netherlands, Leiden, the Netherlands
| | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, United Kingdom
| | - Laurent Arnaud
- Department of Rheumatology, CRMR RESO, University Hospitals of Strasbourg, Strasbourg, France
| | - Tiffany K Gill
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Australia
| | - Ellen Moholt
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Norway
| | - Jennifer Burt
- Newfoundland and Labrador Health Services, St. Clare's Mercy Hospital, St John's, Newfoundland and Labrador, Canada
| | | | - Ihsane Hmamouchi
- Health Sciences Research Centre (CReSS), Faculty of Medicine, International University of Rabat (UIR), Rabat, Morocco
| | - Dorthe B Berthelsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Department of Rehabilitation, Municipality of Guldborgsund, Nykoebing F, Denmark
| | - Francisco J Blanco
- Departamento de Fisioterapia, Medicina y Ciencias Médicas, Universidad de A Coruña, A Coruña, Spain, Spain
| | | | - Ajesh Maharaj
- Department of Internal Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Beverly Shea
- Bruyère Research Institute; Ottawa Hospital Research Institute; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Christopher Fong
- Eastern Clinical Research Unit, Monash University, Melbourne, Australia
| | - Anthony P Fernandez
- Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College Hospital, School of Immunology and Microbial Sciences, King's College London; Rheumatology Department, King's College Hospital, London, United Kingdom
| | - Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Regina Greer-Smith
- Patient Research Partner, President/CEO, Healthcare Research Associates, LLC/S.T.A.R. Initiative; Ambassador, Patient-Centered Outcomes Research Institute, Apple Valley, CA, USA
| | - Victor S Sloan
- Sheng Consulting LLC, Flemington, New Jersey USA; The Peace Corps, Washington, DC, USA
| | | | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Stanford, California, USA
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
| | - Valerie Umaefulam
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Sara Monti
- Department of Rheumatology, Policlinico S. Matteo, IRCCS Fondazione, University of Pavia, Pavia, Italy
| | - Nouran Abaza
- Professor of Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Simon Stones
- Patient research partner, Envision Pharma Group, Wilmslow, UK
| | - Laure Gossec
- Professor of Rheumatology, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; AP-HP, Pitié-Salpêtrière hospital, Rheumatology department, Paris, France
| | - Sabrina Mai Nielsen
- Musculoskeletal Statistics Unit, the Parker Institute, Department of Rheumatology, Odense University Hospital, and University of Southern Denmark, Copenhagen, Denmark
| | - Sabrina Cavallo
- School of Rehabilitation, Faculty of Medicine, University of Montreal; Researcher Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada; Sainte-Justine University Health Center Research Center, Montreal, Canada
| | - Hemalatha Srinivasalu
- Pediatric Rheumatology, Children's National Hospital; GW School of Medicine, Washington, DC, USA
| | - Deb Constien
- Patient Research Partner, Central Regional Lead, Advocacy Leadership Board Chair, International Foundation of Autoimmune Autoinflammatory Arthritis (AiArthritis), Madison, Wisconsin, USA
| | - Vicki Evans
- Patient Research Partner and Discipline of Optometry, Faculty of Health, University of Canberra, Canberra, Australia
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa; Department of Pediatrics, Faculty of Medicine, University of Ottawa; Affiliate scientist, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; Institut du savoir Montfort, Ottawa, Canada.
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Subdar S, Hoens AM, White K, Hartfeld NMS, Dhiman K, Duffey K, Heath CE, Lamoureux G, Graveline C, Davidson E, Hazlewood G, Lacaille D, Lopatina E, Barber MRW, Then KL, Crump T, Zafar S, Manske SL, Charlton A, Osinski K, Fifi-Mah A, Mosher D, Barber CEH. An Environmental Scan and Appraisal of Patient Online Resources for Managing Rheumatoid Arthritis Flares. J Rheumatol 2024:jrheum.2023-1025. [PMID: 38490667 DOI: 10.3899/jrheum.2023-1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To conduct an environmental scan and appraisal of online patient resources to support rheumatoid arthritis (RA) flare self-management. METHODS We used the Google search engine (last search March 2023) using the terms "rheumatoid arthritis" and "flare management." Additional searches targeted major arthritis organizations, as well as regional, national, and international resources. Appraisal of the resources was conducted by 2 research team members and 1 patient partner to assess the understandability and actionability of the resource using the Patient Education Materials Assessment Tool (PEMAT). Resources rating ≥ 60% in both domains by either the research team or the patient partner were further considered for content review. During content review, resources were excluded if they contained product advertisements, inaccurate information, or use of noninclusive language. If content review criteria were met, resources were designated as "highly recommended" if both patient partners and researchers' PEMAT ratings were ≥ 60%. If PEMAT ratings were divergent and had a rating ≥ 60% from only 1 group of reviewers, the resource was designated "acceptable." RESULTS We identified 44 resources; 12 were excluded as they did not pass the PEMAT assessment. Fourteen resources received ratings ≥ 60% on understandability and actionability from both researchers and patient partners; 10 of these were retained following content review as "highly recommended" flare resources. Of the 18 divergent PEMAT ratings, 8 resources were retained as "acceptable" following content review. CONCLUSION There is high variability in the actionability and understandability of online RA flare materials; only 23% of resources were highly recommended by researchers and patient partners.
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Affiliation(s)
- Shakeel Subdar
- S. Subdar, HBSc, University of Toronto, Toronto, Ontario
| | - Alison M Hoens
- A.M. Hoens, PT, MSc, Arthritis Research Canada, and Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia
| | - Krista White
- K. White, MA, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Nicole M S Hartfeld
- N.M.S. Hartfeld, MSc, MC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Kiran Dhiman
- K. Dhiman, MPH, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Keeva Duffey
- K. Duffey, MPH, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Claire E Heath
- C.E. Heath, MN, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Gisele Lamoureux
- G. Lamoureux, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Christine Graveline
- C. Graveline, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Eileen Davidson
- E. Davidson, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Glen Hazlewood
- G. Hazlewood, MD, PhD, Arthritis Research Canada, Vancouver, British Columbia, and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Diane Lacaille
- D. Lacaille, MDCM, MHSc, Arthritis Research Canada, and Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Elena Lopatina
- E. Lopatina, MD, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta
| | - Megan R W Barber
- M.R.W. Barber, MD, PhD, Arthritis Research Canada, Vancouver, British Columbia, and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Karen L Then
- K.L. Then, ACNP, PhD, Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Trafford Crump
- T. Crump, PhD, Department of Surgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec
| | - Saania Zafar
- S. Zafar, BCR, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Sarah L Manske
- S.L. Manske, PhD, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Alexandra Charlton
- A. Charlton, BScPharm, PharmD, Alberta Health Services, Calgary, Alberta
| | - Kelly Osinski
- K. Osinski, RN, BN, Alberta Health Services, Calgary, Alberta
| | - Aurore Fifi-Mah
- A. Fifi-Mah, MD, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Dianne Mosher
- D. Mosher, MD, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Claire E H Barber
- C.E.H. Barber, MD, PhD, Arthritis Research Canada, Vancouver, British Columbia, and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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4
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Barber CEH, Lethebe BC, Szostakiwskyj JH, Barnabe C, Barber MRW, Katz S, England BR, Hazlewood GS. A population-based analysis of rheumatology care patterns for inflammatory arthritis during COVID-19 in Alberta, Canada. Semin Arthritis Rheum 2024; 65:152364. [PMID: 38237230 DOI: 10.1016/j.semarthrit.2024.152364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The aim of the study was to understand the impact of the COVID-19 pandemic on inflammatory arthritis (IA) rheumatology care in Alberta, Canada. METHODS We used linked provincial health administrative datasets to establish an incident cohort of individuals with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and Ankylosing Spondylitis (AS) seen at least once by a rheumatologist. We examined incidence rates (IR) per 100,000 population, and patterns of follow-up care between 2011 and 2022. In a subset of individuals diagnosed five years prior to the pandemic, we report on those lost to follow-up during the pandemic, and those with virtual care visits followed by in-person visit within 30 days. Multivariable logistic regression was used to examine patient characteristics associated with these patterns of care. RESULTS The IR for RA in 2020 declined compared to previous years (44.6), but not for AS (9.2) or PsA (9.1). In 2021 IRs rose (RA 49.5; AS 11.8; PsA 11.8). Among those diagnosed within 5 years of the pandemic, 632 (6.0 %) were lost to follow-up, with characteristics of those lost to follow-up differing between IA types. 1444 individuals had at least one virtual visit followed within 30 days by an in-person follow-up. This was less common in males (OR 0.69-0.79) and more common for those with a higher frequency of physician visits prior to the pandemic (OR 1.27-1.32). CONCLUSION Impacts of patterns of care during the pandemic should be further explored for healthcare planning to uphold optimal care access and promote effective use of virtual care.
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Affiliation(s)
- Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada.
| | - Brendan Cord Lethebe
- Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Megan R W Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Steven Katz
- Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Bryant R England
- VA Nebraska-Western Iowa Health Care System & University of Nebraska Medical Center, Omaha, NE, USA
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
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5
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Naye F, Toupin-April K, de Wit M, LeBlanc A, Dubois O, Boonen A, Barton JL, Fraenkel L, Li LC, Stacey D, March L, Barber CEH, Hazlewood GS, Guillemin F, Bartlett SJ, Berthelsen DB, Mather K, Arnaud L, Akpabio A, Adebajo A, Schultz G, Sloan VS, Gill TK, Sharma S, Scholte-Voshaar M, Caso F, Nikiphorou E, Nasef SI, Campbell W, Meara A, Christensen R, Suarez-Almazor ME, Jull JE, Alten R, Morgan EM, El-Miedany Y, Singh JA, Burt J, Jayatilleke A, Hmamouchi I, Blanco FJ, Fernandez AP, Mackie S, Jones A, Strand V, Monti S, Stones SR, Lee RR, Nielsen SM, Evans V, Srinivasalu H, Gérard T, Demers JL, Bouchard R, Stefan T, Dugas M, Bergeron F, Beaton D, Maxwell LJ, Tugwell P, Décary S. OMERACT Core outcome measurement set for shared decision making in rheumatic and musculoskeletal conditions: a scoping review to identify candidate instruments. Semin Arthritis Rheum 2024; 65:152344. [PMID: 38232625 DOI: 10.1016/j.semarthrit.2023.152344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES Shared decision making (SDM) is a central tenet in rheumatic and musculoskeletal care. The lack of standardization regarding SDM instruments and outcomes in clinical trials threatens the comparative effectiveness of interventions. The Outcome Measures in Rheumatology (OMERACT) SDM Working Group is developing a Core Outcome Set for trials of SDM interventions in rheumatology and musculoskeletal health. The working group reached consensus on a Core Outcome Domain Set in 2020. The next step is to develop a Core Outcome Measurement Set through the OMERACT Filter 2.2. METHODS We conducted a scoping review (PRISMA-ScR) to identify candidate instruments for the OMERACT Filter 2.2 We systematically reviewed five databases (Ovid MEDLINE®, Embase, Cochrane Library, CINAHL and Web of Science). An information specialist designed search strategies to identify all measurement instruments used in SDM studies in adults or children living with rheumatic or musculoskeletal diseases or their important others. Paired reviewers independently screened titles, abstracts, and full text articles. We extracted characteristics of all candidate instruments (e.g., measured construct, measurement properties). We classified candidate instruments and summarized evidence gaps with an adapted version of the Summary of Measurement Properties (SOMP) table. RESULTS We found 14,464 citations, read 239 full text articles, and included 99 eligible studies. We identified 220 potential candidate instruments. The five most used measurement instruments were the Decisional Conflict Scale (traditional and low literacy versions) (n=38), the Hip/Knee-Decision Quality Instrument (n=20), the Decision Regret Scale (n=9), the Preparation for Decision Making Scale (n=8), and the CollaboRATE (n=8). Only 44 candidate instruments (20%) had any measurement properties reported by the included studies. Of these instruments, only 57% matched with at least one of the 7-criteria adapted SOMP table. CONCLUSION We identified 220 candidate instruments used in the SDM literature amongst people with rheumatic and musculoskeletal diseases. Our classification of instruments showed evidence gaps and inconsistent reporting of measurement properties. The next steps for the OMERACT SDM Working Group are to match candidate instruments with Core Domains, assess feasibility and review validation studies of measurement instruments in rheumatic diseases or other conditions. Development and validation of new instruments may be required for some Core Domains.
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Affiliation(s)
- Florian Naye
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; Institut du savoir Montfort, Ottawa, Canada
| | | | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada; VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Olivia Dubois
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jennifer L Barton
- VA Portland Health Care System, Oregon Health & Science University, Portland, USA
| | - Liana Fraenkel
- Department of Internal Medicine, Yale University, New Haven, USA
| | - Linda C Li
- Department of Physical Therapy, Arthritis Research Canada, University of British Columbia, Vancouver, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lyn March
- Department of Medicine, The University of Sydney, Sydney, Australia; Institute of Bone and Joint Research, Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - Claire E H Barber
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Susan J Bartlett
- Divisions of Clinical Epidemiology, Rheumatology and Respiratory Epidemiology and Clinical Trials Unit, McGill University, Canada; Research Institute - McGill University Health Centre, Canada; Johns Hopkins Medicine Division of Rheumatology, Montreal, Canada
| | - Dorthe B Berthelsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen & Research Unit of Rheumatology, Department of Clinical Research, Odense & Department of Rehabilitation, Municipality of Guldborgsund, Odense University Hospital, University of Southern Denmark, Nykoebing, Denmark
| | | | - Laurent Arnaud
- Department of Rheumatology, CRMR RESO, University Hospitals of Strasbourg, France
| | | | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, UK
| | | | - Victor S Sloan
- Sheng Consulting LLC, Flemington, NJ, USA; The Peace Corps, Washington, DC, USA
| | - Tiffany K Gill
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Marieke Scholte-Voshaar
- Patient Research Partner, Department of Pharmacy and Department of Research & Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Pharmacy, Radboud university medical center, Nijmegen
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College Hospital, School of Immunology and Microbial Sciences, King's College London, UK; Rheumatology Department, King's College Hospital, London, UK
| | - Samah Ismail Nasef
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Willemina Campbell
- Patient research partner, Toronto Western Hospital, University Health Network, Canada
| | - Alexa Meara
- Division of Rheumatology, The Ohio State University, Columbus, USA
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, & Department of Rheumatology, Odense University Hospital, Denmark
| | - Maria E Suarez-Almazor
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Rieke Alten
- Department of Internal Medicine II, Rheumatology Research Center, Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany
| | - Esi M Morgan
- Department of Pediatrics, University of Washington, Division of Rheumatology, Seattle Children's Hospital, Seattle, Washington, USA
| | | | | | - Jennifer Burt
- Newfoundland and Labrador Health Services, St. Clare's Mercy Hospital, St John's, Newfoundland and Labrador, Canada
| | | | - Ihsane Hmamouchi
- Health Sciences Research Centre (CReSS), Faculty of Medicine, International University of Rabat (UIR), Rabat, Morocco
| | - Francisco J Blanco
- Departamento de Fisioterapia, Medicina y Ciencias Médicas, Universidad de A Coruña, A Coruña, Spain
| | - Anthony P Fernandez
- Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Stanford, California, USA
| | - Sara Monti
- Department of Rheumatology, Policlinico S. Matteo, IRCCS Fondazione, University of Pavia, Pavia, Italy
| | - Simon R Stones
- Patient research partner, Envision Pharma Group, Wilmslow, UK
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
| | - Sabrina Mai Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Odense University Hospital, and University of Southern Denmark, Copenhagen, Demark, Copenhagen, Denmark
| | - Vicki Evans
- Patient Research Partner and Discipline of Optometry, Faculty of Health, University of Canberra, Canberra, Australia
| | - Hemalatha Srinivasalu
- Pediatric Rheumatology, Children's National Hospital, Washington DC, USA; GW School of Medicine, Washington DC, USA
| | - Thomas Gérard
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | | | - Roxanne Bouchard
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | - Théo Stefan
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | - Michèle Dugas
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | | | | | - Lara J Maxwell
- Centre for Practice Changing Research, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Simon Décary
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada.
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Marshall DA, Tagimacruz T, Barber CEH, Cepoiu-Martin M, Lopatina E, Robert J, Lupton T, Patel J, Mosher DP. Intended and unintended consequences of strategies to meet performance benchmarks for rheumatologist referrals in a centralized intake system. J Eval Clin Pract 2024; 30:199-208. [PMID: 37723891 DOI: 10.1111/jep.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/29/2023] [Accepted: 09/02/2023] [Indexed: 09/20/2023]
Abstract
RATIONALE Timely assessment of a chronic condition is critical to prevent long-term irreversible consequences. Patients with inflammatory arthritis (IA) symptoms require diagnosis by a rheumatologist and intervention initiation to minimize potential joint damage. With limited rheumatologist capacity, meeting urgency wait time benchmarks can be challenging. We investigate the impact of the maximum wait time guarantee (MWTG) policy and referral volume changes in a rheumatology central intake (CI) system on meeting this challenge. METHODS We applied a system simulation approach to model a high-volume CI rheumatology clinic. Model parameters were based on the referral and triage data from the CI and clinic appointment data. We compare the wait time performance of the current distribution policy MWTG and when referral volumes change. RESULTS The MWTG policy ensures 100% of new patients see a rheumatologist within their urgency wait time benchmark. However, the average wait time for new patients increased by 51% (178-269 days). A 10% decrease in referrals resulted in a 76% decrease on average wait times (178-43 days) for new patients and an increase in the number of patients seen by a rheumatologist within 1 year of the initial visit. CONCLUSION An MWTG policy can result in intended and unintended consequences-ensuring that all patients meet the wait time benchmarks but increasing wait times overall. Relatively small changes in referral volume significantly impact wait times. These relationships can assist clinic managers and policymakers decide on the best approach to manage referrals for better system performance.
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Affiliation(s)
- Deborah A Marshall
- McCaig Bone and Joint Health Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Toni Tagimacruz
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Claire E H Barber
- McCaig Bone and Joint Health Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Monica Cepoiu-Martin
- McCaig Bone and Joint Health Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Elena Lopatina
- McCaig Bone and Joint Health Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jill Robert
- Surgery and Bone & Joint Strategic Clinical Network™, Alberta Health Services, Edmonton, Alberta, Canada
| | - Terri Lupton
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jatin Patel
- Strategic Clinical Network™, Alberta Health Services, Edmonton, Alberta, Canada
| | - Diane P Mosher
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Zafar SN, Hazlewood G, Dhiman K, Charlton A, Then KL, Dempsey E, Lester R, Hoens AM, Lacaille D, Barnabe C, Rankin J, Mosher D, Barber CEH. "How are you?" Perspectives From Patients and Health Care Providers of Text Messaging to Support Rheumatoid Arthritis Care: A Thematic Analysis. ACR Open Rheumatol 2024. [PMID: 38376004 DOI: 10.1002/acr2.11652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) may need to access rheumatology care between scheduled visits. WelTel is a virtual care platform that supports secure two-way text-messaging between patients and their health care team. The objective of the present study was to explore perspectives and experiences of health care providers (HCPs) and patients related to the use of WelTel as an adjunct to routine care. METHODS Seventy patients with RA were enrolled in a six-month WelTel pilot project launched in September 2021. Patients received monthly "How are you?" text message check-ins and could message their health care team during clinic hours to request health advice. The current project is a qualitative study of the WelTel pilot. A subgroup of pilot participants was purposively sampled and invited to participate in interviews. A thematic analysis of transcripts was conducted using a deductive approach leveraging quality of care domains. RESULTS Thirteen patients (62% female, mean age 62 years, 10 White) completed interviews. Patients' views suggested that text messaging with the rheumatology team supported high-quality care across multiple quality domains including patient-centeredness, timeliness, efficiency, safety, effectiveness, equity, and appropriateness. Seven HCPs (57.1% female, one pharmacist and six rheumatologists) completed interviews. HCPs' perspectives varied based on their experience with the WelTel platform. Additional themes reported by HCPs included perceived increased workload and burnout. CONCLUSIONS Patients with RA perceived text-based messaging as supporting high-quality care. The impact of increased communications on HCP burnout and workload requires consideration, and future studies should evaluate the effect of texting on patient outcomes.
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Affiliation(s)
- Saania N Zafar
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Glen Hazlewood
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | | | | | - Karen L Then
- Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Erika Dempsey
- Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Richard Lester
- University of British Columbia and WelTel Inc, Vancouver, British Columbia, Canada
| | - Alison M Hoens
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Cheryl Barnabe
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - James Rankin
- University of Calgary, Calgary, Alberta, Canada, and Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Dianne Mosher
- Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Claire E H Barber
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
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Dhiman K, Hall M, Crump T, Hoens AM, Lacaille D, Rankin JA, Then KL, Hazlewood G, Barnabe C, Katz S, Sutherland J, Dempsey E, Barber CEH. Content validity testing of the INTERMED Self-Assessment in a sample of adults with rheumatoid arthritis and rheumatology healthcare providers. Health Expect 2024; 27:e13978. [PMID: 38366795 PMCID: PMC10873686 DOI: 10.1111/hex.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Care complexity can occur when patients experience health challenges simultaneously with social barriers including food and/or housing insecurity, lack of transportation or other factors that impact care and patient outcomes. People with rheumatoid arthritis (RA) may experience care complexity due to the chronicity of their condition and other biopsychosocial factors. There are few standardised instruments that measure care complexity and none that measure care complexity specifically in people with RA. OBJECTIVES We assessed the content validity of the INTERMEDS Self-Assessment (IMSA) instrument that measures care complexity with a sample of adults with RA and rheumatology healthcare providers (HCPs). Cognitive debriefing interviews utilising a reparative framework were conducted. METHODS Patient participants were recruited through two existing studies where participants agreed to be contacted about future studies. Study information was also shared through email blasts, posters and brochures at rheumatology clinic sites and trusted arthritis websites. Various rheumatology HCPs were recruited through email blasts, and divisional emails and announcements. Interviews were conducted with nine patients living with RA and five rheumatology HCPs. RESULTS Three main reparative themes were identified: (1) Lack of item clarity and standardisation including problems with item phrasing, inconsistency of the items and/or answer sets and noninclusive language; (2) item barrelling, where items asked about more than one issue, but only allowed a single answer choice; and (3) timeframes presented in the item or answer choices were either too long or too short, and did not fit the lived experiences of patients. Items predicting future healthcare needs were difficult to answer due to the episodic and fluctuating nature of RA. CONCLUSIONS Despite international use of the IMSA to measure care complexity, patients with RA and rheumatology HCPs in our setting perceived that it did not have content validity for use in RA and that revision for use in this population under a reparative framework was unfeasible. Future instrument development requires an iterative cognitive debriefing and repair process with the population of interest in the early stages to ensure content validity and comprehension. PATIENT OR PUBLIC CONTRIBUTION Patient and public contributions included both patient partners on the study team and people with RA who participated in the study. Patient partners were involved in study design, analysis and interpretation of the findings and manuscript preparation. Data analysis was structured according to emergent themes of the data that were grounded in patient perspectives and experiences.
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Affiliation(s)
- Kiran Dhiman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marc Hall
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Trafford Crump
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alison M Hoens
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - James A Rankin
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Karen L Then
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
| | - Steven Katz
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jason Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erika Dempsey
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
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9
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Subdar S, Dhiman K, Hartfeld NMS, Hoens AM, White K, Manske SL, Hazlewood G, Lacaille D, Lopatina E, Barber MRW, Mosher D, Fifi-Mah A, Twilt M, Luca N, Then KL, Crump T, Zafar S, Osinski K, Barber CEH. Investigating the influence of patient eligibility characteristics on the number of deferrable rheumatologist visits: planning for a patient-initiated follow-up (PIFU) strategy. J Rheumatol 2024:jrheum.2023-0891. [PMID: 38302163 DOI: 10.3899/jrheum.2023-0891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Patient-initiated follow-up (PIFU) for rheumatoid arthritis (RA) is a model of care delivery wherein patients contact the clinic when needed instead of regularly scheduled followups. Our objective was to investigate the influence of different patient eligibility characteristics on the number of potentially deferred visits to inform future implementation of a PIFU strategy. METHODS We conducted a retrospective chart review of seven rheumatologists' practices at two university-based clinics between 01/03/2021-28/02/2022. Data extracted included the type and frequency of visits, disease management, comorbidities, and care complexities. Stable disease was defined as remission or low-disease activity with no medication changes at all visits. The influence of patient characteristics on the number of deferrable visits in patients with stable disease was explored in four criteria sets that were based on: early disease duration, medication prescribed, presence of care complexity elements, and comorbidity burden. RESULTS Records from 770 visits were reviewed from 365 RA patients (71.5% female, 70.0% seropositive). Among all criteria sets, the proportion of visits that could be redirected varied between 2.5%-20.9%. The highest proportion of deferrable visits was achieved when eligibility criteria included only stable disease activity and RA patients on conventional synthetic disease modifying drugs or no medications (n=161, 20.9%). CONCLUSION PIFU may result in a more efficient use of specialist healthcare resources. However, the applicability of such models of care and the number of deferred visits is highly dependent on patient characteristics used to establish eligibility criteria for that model. These findings should be considered when planning implementation trials.
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Affiliation(s)
- Shakeel Subdar
- Shakeel Subdar HBSc, University of Toronto, Toronto, Ontario, Canada
| | - Kiran Dhiman
- Kiran Dhiman MPH, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole M S Hartfeld
- Nicole M.S. Hartfeld MSc MC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alison M Hoens
- Alison M. Hoens PT MSc, Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Krista White
- Krista White MA, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sarah L Manske
- Sarah L. Manske PhD, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Glen Hazlewood
- Glen Hazlewood MD PhD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,, Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lacaille
- Diane Lacaille MDCM MHSc FRCPC, Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Elena Lopatina
- Elena Lopatina MD PhD, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Megan R W Barber
- Megan R.W. Barber MD PhD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Mosher
- Dianne Mosher MD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aurore Fifi-Mah
- Aurore Fifi-Mah MD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marinka Twilt
- Marinka Twilt MD MSCE PhD, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nadia Luca
- Nadia Luca MD FRCPC MSc, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen L Then
- Karen L. Then ACNP PhD, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Trafford Crump
- Trafford Crump PhD, Department of Surgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Saania Zafar
- Saania Zafar BCR, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly Osinski
- Kelly Osinski, Alberta Health Services, Calgary, Alberta, Canada
| | - Claire E H Barber
- Claire E.H. Barber MD PhD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Katz PP, Barber CEH, Duarte-García A, Garg S, Machua W, Rodgers W, Santiago-Casas Y, Suter L, Bartels CM, Yazdany J. Development of the American College of Rheumatology Patient-Reported Outcome Quality Measures for Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2024. [PMID: 38225171 DOI: 10.1002/acr.25301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/27/2023] [Accepted: 01/11/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE As part of a Centers for Disease Control and Prevention-funded American College of Rheumatology (ACR) initiative, we sought to develop quality measures related to Patient Reported Outcome Measure (PROM) use for systemic lupus erythematosus (SLE) clinical care. METHODS An expert workgroup composed of physician, patient, and researcher representatives convened to identify patient-reported outcome (PRO) domains of greatest importance to people with SLE. A patient advisory panel separately ranked domains. PROMs assessing priority domains were identified through structured literature review, and detailed psychometric reviews were conducted for each PROM. In a Delphi process, the expert workgroup rated PROMs on content validity, psychometric quality, feasibility of implementation, and importance for guiding patient self-management. The patient advisory panel reviewed PROMs in parallel and contributed to the final recommendations. RESULTS Among relevant PRO domains, the workgroup and patient partners ranked depression, physical function, pain, cognition, and fatigue as high-priority domains. The workgroup recommended at least once yearly measurement for (1) assessment of depression using the Patient Health Questionnaire or Patient Reported Outcomes Measurement Information System (PROMIS) depression scales; (2) assessment of physical function using PROMIS physical function scales or the Multi-Dimensional Health Assessment Questionnaire; and (3) optional assessments of fatigue and cognition. Pain scales evaluated were not found to be sufficiently superior to what is already assessed in most SLE clinic visits. CONCLUSION Expert workgroup members and patient partners recommend that clinicians assess depression and physical function at least once yearly in all people with SLE. Additional PROMs addressing cognition and fatigue can also be assessed. Next steps are to incorporate PROM-based quality measures into the ACR The Rheumatology Informatics System for Effectiveness registry.
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Affiliation(s)
| | | | | | - Shivani Garg
- University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Wendy Rodgers
- Lupus Foundation Care and Support Services, Los Angeles, California
| | | | - Lisa Suter
- Yale School of Medicine, New Haven, Connecticut, and Veterans Administration Hospital, West Haven, Connecticut
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Bartels CM, Jorge A, Feldman CH, Zell J, Bermas B, Barber CEH, Duarte-García A, Garg S, Haseley L, Jatwani S, Johansson T, Limanni A, Rodgers W, Rovin BH, Santiago-Casas Y, Suter LG, Barnado A, Ude J, Aguirre A, Li J, Schmajuk G, Yazdany J. Development of American College of Rheumatology Quality Measures for Systemic Lupus Erythematosus: A Modified Delphi Process With Rheumatology Informatics System for Effectiveness (RISE) Registry Data Review. Arthritis Care Res (Hoboken) 2023; 75:2295-2305. [PMID: 37165898 PMCID: PMC10615706 DOI: 10.1002/acr.25143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/04/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE We aimed to develop readily measurable digital quality measure statements for clinical care in systemic lupus erythematosus (SLE) using a multistep process guided by consensus methods. METHODS Using a modified Delphi process, an American College of Rheumatology (ACR) workgroup of SLE experts reviewed all North American and European guidelines from 2000 to 2020 on treatment, monitoring, and phenotyping of patients with lupus. Workgroup members extracted quality constructs from guidelines, rated these by importance and feasibility, and generated evidence-based quality measure statements. The ACR Rheumatology Informatics System for Effectiveness (RISE) Registry was queried for measurement data availability. In 3 consecutive Delphi sessions, a multidisciplinary Delphi panel voted on the importance and feasibility of each statement. Proposed measures with consensus on feasibility and importance were ranked to identify the top 3 measures. RESULTS Review of guidelines and distillation of 57 quality constructs resulted in 15 quality measure statements. Among these, 5 met high consensus for importance and feasibility, including 2 on treatment and 3 on laboratory monitoring measures. The 3 highest-ranked statements were recommended for further measure specification as SLE digital quality measures: 1) hydroxychloroquine use, 2) limiting glucocorticoid use >7.5 mg/day to <6 months, and 3) end-organ monitoring of kidney function and urine protein excretion at least every 6 months. CONCLUSION The Delphi process selected 3 quality measures for SLE care on hydroxychloroquine, glucocorticoid reduction, and kidney monitoring. Next, measures will undergo specification and validity testing in RISE and US rheumatology practices as the foundation for national implementation and use in quality improvement programs.
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Affiliation(s)
| | | | | | | | | | | | | | - Shivani Garg
- University of Wisconsin School of Medicine and Public Health, Madison
| | | | | | | | | | - Wendy Rodgers
- Lupus Foundation Care and Support Services, Los Angeles, California
| | - Brad H Rovin
- Ohio State University Wexner Medical Center, Columbus
| | | | - Lisa G Suter
- Yale School of Medicine, New Haven, and Veterans Administration Medical Center, West Haven, Connecticut
| | - April Barnado
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer Ude
- American College of Rheumatology, Atlanta, Georgia
| | | | - Jing Li
- University of California San Francisco
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Kheirkhah H, Hartfeld NMS, Widdifield J, Kulhawy-Wibe S, Roberts J, Yacyshyn EA, Lee JJY, Jilkine K, Jerome D, Kwok TSH, Burt J, Barber CEH. An Overview of Reviews to Inform Organization-Level Interventions to Address Burnout in Rheumatologists. J Rheumatol 2023; 50:1488-1502. [PMID: 37527857 DOI: 10.3899/jrheum.2023-0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To identify organization-directed strategies that could be implemented to prevent burnout among rheumatologists. METHODS A search of English language articles published 2011 or later was conducted on Cochrane Database of Systematic Reviews, Embase, Medline, and PsycInfo on January 25, 2022. Included reviews had ≥ 1 primary studies with ≥ 10% of participants who were physicians, recorded burnout as an outcome, and described an organization-directed intervention to prevent burnout. Overlap of primary studies across reviews was assessed. The final review inclusion was determined by study quality, minimization of overlap, and maximization of intervention breadth. The A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 tool was used for quality assessment. Included studies and interventions were assessed by rheumatologists for their applicability to rheumatology. RESULTS A total of 17 reviews, including 15 systematic reviews, 1 realist review, and 1 umbrella review were included. AMSTAR 2 quality ratings classified 5 systematic reviews as low quality, 1 as moderate, and 9 as critically low. There was significant heterogeneity between and within reviews. Six conducted a metaanalysis and 11 provided a qualitative summary of findings. The following intervention types were identified as having possible applicability to rheumatology: physician workflow and organizational strategies; peer support and formal communication training; leadership support; and addressing stress, mental health, and mindfulness. Across interventions, mindfulness had the highest quality of evidence to support its effectiveness. CONCLUSION Although the quality of evidence for interventions to prevent burnout in physicians is low, promising strategies such as mindfulness have been identified.
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Affiliation(s)
- Hengameh Kheirkhah
- H. Kheirkhah, MD, N.M.S. Hartfeld, MSc, MC, S. Kulhawy-Wibe, MD, MSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Nicole M S Hartfeld
- H. Kheirkhah, MD, N.M.S. Hartfeld, MSc, MC, S. Kulhawy-Wibe, MD, MSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Jessica Widdifield
- J. Widdifield, PhD, Sunnybrook Research Institute, University of Toronto, ICES, Toronto, Ontario
| | - Stephanie Kulhawy-Wibe
- H. Kheirkhah, MD, N.M.S. Hartfeld, MSc, MC, S. Kulhawy-Wibe, MD, MSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Janet Roberts
- J. Roberts, MD, Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Elaine A Yacyshyn
- E.A. Yacyshyn, MD, MScHQ, Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Jennifer J Y Lee
- J.J.Y. Lee, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Konstantin Jilkine
- K. Jilkine, MD, Section of Rheumatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Dana Jerome
- D. Jerome, MD, MEd, T.S.H. Kwok, MD, MSc, Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Timothy S H Kwok
- D. Jerome, MD, MEd, T.S.H. Kwok, MD, MSc, Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Jennifer Burt
- J. Burt, PT, ACPAC-trained ERP, Rheumatology Services, Eastern Health, St. John's, Newfoundland and Labrador
| | - Claire E H Barber
- C.E.H. Barber, MD, PhD, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada.
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Hazlewood GS, Akhavan P, Pardo JP, Agarwal A, Schieir O, Barber CEH, Proulx L, Richards DP, Bombardier C, Pope JE, Barnabe C, Tugwell P, Jamal S, Thorne JC, Nikolic RPA, Khraishi M, Bansback N, Legge A, Bykerk V, Taylor-Gjevre R. Canadian Rheumatology Association Living Guidelines for Rheumatoid Arthritis: Update #1. J Rheumatol 2023; 50:1198-1199. [PMID: 37527865 DOI: 10.3899/jrheum.2023-0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Affiliation(s)
- Glen S Hazlewood
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Pooneh Akhavan
- Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jordi Pardo Pardo
- Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada
| | - Arnav Agarwal
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
| | - Orit Schieir
- Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada
| | - Claire E H Barber
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Laurie Proulx
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Dawn P Richards
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Janet E Pope
- Department of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Peter Tugwell
- Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Shahin Jamal
- Division of Rheumatology, University of British Columbia, Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - J Carter Thorne
- The Arthritis Program Research Group, Newmarket, Ontario, Canada
| | - Roko P A Nikolic
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Majed Khraishi
- Department of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Nick Bansback
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra Legge
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vivian Bykerk
- Hospital for Special Surgery, Weill Cornell Medicine (Cornell University), New York, New York, USA
| | - Regina Taylor-Gjevre
- Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan, Saskatchewan, Manitoba, Canada
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14
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Lopatina E, Barber CEH, LeClercq SA, Noseworthy TW, Suter E, Mosher DP, Marshall DA. Healthcare resource utilization and costs in stable patients with rheumatoid arthritis: Comparing nurse-led and rheumatologist-led models of care delivery. Semin Arthritis Rheum 2023; 59:152160. [PMID: 36603500 DOI: 10.1016/j.semarthrit.2022.152160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Having previously shown similar clinical outcomes, this study compared the healthcare resource utilization and direct costs in stable patients with RA followed in the nurse-led care (NLC) and rheumatologist-led care (RLC) models. METHODS Previously collected clinical data were linked to data on practitioner claims, ambulatory care, and hospital discharges. Assessed resources included physician visits; emergency department (ED) visits; hospital admissions, and disease-modifying anti-rheumatic drugs (DMARDs). The mean per-patient resource utilization and cost (2020 Canadian dollars) over 1 year were compared between the groups using Wilcoxon rank-sum test. The mean per-patient cost of health services and total cost were also estimated using Generalized Linear Models (GLMs) accounting for the baseline differences between the groups. RESULTS Overall, 244 patients were included. No differences in the number of visits to the ED or to general practice and internal medicine physicians and orthopedic surgeons were found. The NLC group had fewer hospitalizations than the RLC group (p-value=0.03). The mean cost of health services was not statistically different in NLC and RLC groups ($2275 vs. $3772, p-value=0.30). The RLC group included more patients on biologic DMARDs, contributing to a higher mean total cost than the NLC group ($9191 vs. $3056, p-value<0.01). The mean cost estimates with GLMs were consistent with the observed costs. CONCLUSIONS A nurse-led model of care delivery for stable patients with RA was not associated with increases in healthcare resource utilization or cost as compared to RLC. NLC is one approach to meeting patient needs and better managing scarce healthcare resources.
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Affiliation(s)
- Elena Lopatina
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Claire E H Barber
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sharon A LeClercq
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tom W Noseworthy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Esther Suter
- Department of Social Work, University of Calgary, Calgary, AB, Canada
| | - Dianne P Mosher
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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15
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Bhangu G, Hartfeld NMS, Lacaille D, Lopatina E, Hoens AM, Barber MRW, Then KL, Zafar S, Fifi-Mah A, Hazlewood G, Barber CEH. A scoping review of shared care models for rheumatoid arthritis with patient-initiated follow-up. Semin Arthritis Rheum 2023; 60:152190. [PMID: 36934470 DOI: 10.1016/j.semarthrit.2023.152190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE An emerging strategy to address access challenges to rheumatologists for patients with RA is shared care between primary and specialist care, with patient-initiated rheumatologist follow-up as needed. The objective of this scoping review was to explore studies implementing this model of care. METHODS Four electronic databases were searched from 01/01/2000-31/03/2022 using three main concepts (RA, shared care, patient-initiated follow-up). English-language studies of any design were included if they described the implementation and/or outcomes of shared care model for RA with patient-initiated follow-up. Two authors reviewed and selected articles in duplicate and extracted data on study characteristics, care model implementation and outcomes according to a pre-specified protocol. RESULTS Following duplicate removal, 1578 articles were screened for inclusion and 58 underwent full-text review. Sixteen articles were included, representing 10 unique studies. Five studies had qualitative outcomes and two were pre-implementation studies. Model implementation varied significantly between studies. Effectiveness data was available in 10 studies and demonstrated equivalent outcomes for the model of care (disease activity, radiographic damage, quality of life). Health system costs were equivalent or lower than usual care. While satisfaction with care was equivalent or improved in shared care models with patient-initiated follow-up, some concerns were expressed in qualitative evaluation around appropriate patient selection for such models, and information for health equity evaluation was not reported. CONCLUSIONS While shared care models with patient-initiated follow-up may offer comparable outcomes for RA, further work is required to understand patient preferences, health equity considerations and longer-term outcomes for such models of care.
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Affiliation(s)
- Gurjeet Bhangu
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole M S Hartfeld
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Canada; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elena Lopatina
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alison M Hoens
- Arthritis Research Canada, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Megan R W Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Canada
| | - Karen L Then
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Saania Zafar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Canada
| | - Aurore Fifi-Mah
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Canada
| | - Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Canada.
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16
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Barber CEH, Bartels CM. Making Sense of Multimorbidity in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:207-209. [PMID: 35876632 DOI: 10.1002/acr.24986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/06/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Claire E H Barber
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christie M Bartels
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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17
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Davtyan A, Lee JJY, Eder L, Hawker GA, Luo J, Barber CEH, Thorne JC, Widdifield J. The Effects of Continuity of Rheumatology Care on Emergency Department Utilization and Hospitalizations for Individuals With Early Rheumatoid Arthritis: A Population-Based Study. J Rheumatol 2023:jrheum.220996. [PMID: 36725062 DOI: 10.3899/jrheum.220996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine if continuity of rheumatology care influences rates of emergency department (ED) visits and hospitalizations in patients with rheumatoid arthritis (RA). METHODS A closed inception cohort of patients with RA diagnosed between 2000 and 2009 were followed until December 31, 2019. During the first 5 years following diagnosis, we categorized patients into 3 rheumatology care continuity groups (high, intermediate, and not retained in rheumatology care). Using a landmark analysis, we compared rates of ED visits and hospitalizations during follow-up. Multivariable Poisson regression models were used to estimate rate ratios (RRs), adjusting for demographics, comorbidities, and health services access and supply measures. RESULTS The cohort included 38,528 patients, of which 57.7% (n = 22,221) were classified in the high rheumatology continuity group, 17.2% (n = 6636) were in the intermediate group, and 25.1% (n = 9671) were not retained in rheumatology care. Relative to the high continuity group, both the intermediate and nonretention groups had higher ED rates (RR 1.14, 95% CI 1.08-1.20, and RR 1.12, 95% CI 1.08-1.16, respectively). The intermediate group also experienced higher adjusted hospitalization rates (207.4, 95% CI 203.0-211.8 per 1000 person-years [PY]) than the high continuity group (193.5, 95% CI 191.4-195.6 per 1000 PY). CONCLUSION Patients with RA with higher continuity of rheumatology care had lower rates of ED visits and hospitalizations compared to those who did not receive continuous rheumatology care during the first 5 years of follow-up. These findings provide evidence to support the value of early and continuous rheumatology care for reducing hospitalizations and ED visits.
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Affiliation(s)
- Abel Davtyan
- A. Davtyan, MSc, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
| | - Jennifer J Y Lee
- J.J.Y. Lee, MD, MSc, University of Toronto, Department of Medicine, Toronto, The Hospital for Sick Children (SickKids), Toronto, and ICES, Toronto, Ontario
| | - Lihi Eder
- L. Eder, MD, PhD, Department of Medicine, University of Toronto, and Women's College Hospital Research Institute, Toronto, Ontario
| | - Gillian A Hawker
- G.A Hawker, MD, MSc, Institute of Health Policy, Management, & Evaluation, University of Toronto, Department of Medicine, University of Toronto, ICES, Toronto, and Women's College Hospital Research Institute, Toronto, Ontario
| | - Jin Luo
- J. Luo, MSc, ICES, Toronto, Ontario
| | - Claire E H Barber
- C.E.H. Barber, MD, PhD, The Cumming School of Medicine, University of Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - J Carter Thorne
- J.C. Thorne, MD, Southlake Regional Health Centre, Newmarket, Ontario
| | - Jessica Widdifield
- J. Widdifield, PhD, Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ICES, Toronto, and Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto, Ontario, Canada
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18
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Hazlewood GS, Colmegna I, Hitchon C, Fortin PR, Bernatsky S, Clarke AE, Mosher D, Wilson T, Thomas M, Barber CEH, Harrison M, Bansback N, Proulx L, Richards DP, Kaplan GG. Preferences for COVID-19 Vaccination in People With Chronic Immune-Mediated Inflammatory Diseases. J Rheumatol 2023:jrheum.220697. [PMID: 36642432 DOI: 10.3899/jrheum.220697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To understand how people with chronic immune-mediated inflammatory diseases (IMIDs) trade off the benefits and risks of coronavirus disease 2019 (COVID-19) vaccine options. METHODS We conducted an online discrete-choice experiment in people with IMIDs to quantify the relative importance (RI) of attributes relevant to COVID-19 vaccination. Participants were recruited between May and August 2021 through patient groups and clinics in Canada, and completed 10 choices where they selected 1 of 2 hypothetical vaccine options or no vaccine. The RI of each attribute was estimated and heterogeneity was explored through latent class analysis. RESULTS The survey was completed by 551 people (89% female, mean age 46 yrs) with a range of IMIDs (inflammatory bowel disease [48%], rheumatoid arthritis [38%], systemic lupus erythematosus [16%]). Most had received 1 (94%) or 2 (64%) COVID-19 vaccinations. Across the ranges of levels considered, vaccine effectiveness was most important (RI = 66%), followed by disease flare (21%), rare but serious risks (9%), and number/timing of injections (4%). Patients would accept a risk of disease flare requiring a treatment change of ≤ 8.8% for a vaccine with a small absolute increase in effectiveness (10%). Of the 3 latent classes, the group with the greatest aversion to disease flare were more likely to be male and have lower incomes, but this group still valued effectiveness higher than other attributes. CONCLUSION Patients perceived the benefits of COVID-19 vaccination to outweigh rare serious risks and disease flare. This supports COVID-19 vaccine strategies that maximize effectiveness, while recognizing the heterogeneity in preferences that exists.
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Affiliation(s)
- Glen S Hazlewood
- G.S. Hazlewood, MD, PhD, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Ines Colmegna
- I. Colmegna, MD, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec
| | - Carol Hitchon
- C. Hitchon, MD, MSc, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Paul R Fortin
- P.R. Fortin, MD, Division de Rhumatologie, Departement de Medecine, CHU de Quebec, and Centre de Recherche ARThrite, Universite Laval, Quebec City, Quebec
| | - Sasha Bernatsky
- S. Bernatsky, MD, PhD, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec
| | - Ann E Clarke
- A.E. Clarke, MD, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Dianne Mosher
- D. Mosher, MD, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Todd Wilson
- T. Wilson, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary
| | - Megan Thomas
- M. Thomas, MSc, Arthritis Research Canada, and Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia
| | - Claire E H Barber
- C.E.H. Barber, MD, PhD, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Mark Harrison
- M. Harrison, PhD, Arthritis Research Canada, and Pharmaceutical Sciences, and School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia
| | - Nick Bansback
- N. Bansback, PhD, Arthritis Research Canada, and School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia
| | - Laurie Proulx
- L. Proulx, BCom, Canadian Arthritis Patient Alliance, Ontario
| | - Dawn P Richards
- D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Ontario
| | - Gilaad G Kaplan
- G.G. Kaplan, MD, MPH, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Barber CEH, Lacaille D, Croxford R, Barnabe C, Marshall DA, Abrahamowicz M, Xie H, Aviña-Zubieta JA, Esdaile JM, Hazlewood GS, Faris P, Katz S, MacMullan P, Mosher D, Widdifield J. Investigating Associations Between Access to Rheumatology Care, Treatment, Continuous Care, and Healthcare Utilization and Costs Among Older Individuals With Rheumatoid Arthritis. J Rheumatol 2023; 50:617-624. [PMID: 36642438 DOI: 10.3899/jrheum.220729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To examine the association between rheumatologist access, early treatment, and ongoing care of older-onset rheumatoid arthritis (RA) and healthcare utilization and costs following diagnosis. METHODS We analyzed data from a population-based inception cohort of individuals aged > 65 years with RA in Ontario, Canada, diagnosed between 2002 and 2014 with follow-up to 2019. We assessed 4 performance measures in the first 4 years following diagnosis, including access to rheumatology care, yearly follow-up, timely treatment, and ongoing treatment with a disease-modifying antirheumatic drug. We examined annual healthcare utilization, mean direct healthcare costs, and whether the performance measures were associated with costs in year 5. RESULTS A total of 13,293 individuals met inclusion criteria. The mean age was 73.7 (SD 5.7) years and 68% were female. Total mean direct healthcare cost per individual increased annually and was CAD $13,929 in year 5. All 4 performance measures were met for 35% of individuals. In multivariable analyses, costs for not meeting access to rheumatology care and timely treatment performance measures were 20% (95% CI 8-32) and 6% (95% CI 1-12) higher, respectively, than where those measures were met. The main driver of cost savings among individuals meeting all 4 performance measures were from lower complex continuing care, home care, and long-term care costs, as well as fewer hospitalizations and emergency visits. CONCLUSION Access to rheumatologists for RA diagnosis, timely treatment, and ongoing care are associated with lower total healthcare costs at 5 years. Investments in improving access to care may be associated with long-term health system savings.
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Affiliation(s)
- Claire E H Barber
- C.E.H. Barber, MD, PhD, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Diane Lacaille
- D. Lacaille, MD, MHSc,, Department of Medicine, University of British Columbia, and Arthritis Research Canada, Vancouver, British Columbia
| | | | - Cheryl Barnabe
- C. Barnabe, MD, MSc, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Deborah A Marshall
- D.A. Marshall, PhD, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Michal Abrahamowicz
- M. Abrahamowicz, PhD, Department of Epidemiology & Biostatistics, McGill University, Montreal, Quebec, and Arthritis Research Canada, Vancouver, British Columbia
| | - Hui Xie
- H. Xie, PhD, Faculty of Health Sciences, Simon Fraser University, Burnaby, and Arthritis Research Canada, Vancouver, British Columbia
| | - J Antonio Aviña-Zubieta
- J.A. Aviña-Zubieta, MD, PhD, Department of Medicine, University of British Columbia, and Arthritis Research Canada, Vancouver, British Columbia
| | - John M Esdaile
- J.M. Esdaile, MD, MPH, Department of Medicine, University of British Columbia, and Arthritis Research Canada, Vancouver, British Columbia
| | - Glen S Hazlewood
- G.S. Hazlewood, MD, PhD, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Peter Faris
- P. Faris, PhD, Alberta Health Services, Calgary, Alberta
| | - Steven Katz
- S. Katz, MD, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Paul MacMullan
- P. MacMullan, MB BCh BAO, MRCPI, MD, Department of Medicine, University of Calgary, Calgary, Alberta
| | - Dianne Mosher
- D. Mosher MD, Department of Medicine, University of Calgary, Calgary, Alberta
| | - Jessica Widdifield
- J. Widdifield, PhD, Holland Bone & Joint Program, Sunnybrook Research Institute, and ICES, and Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
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20
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Barber CEH, Lacaille D, Croxford R, Barnabe C, Marshall DA, Abrahamowicz M, Xie H, Avina-Zubieta JA, Esdaile JM, Hazlewood G, Faris P, Katz S, MacMullan P, Mosher D, Widdifield J. System-level performance measures of access to rheumatology care: a population-based retrospective study of trends over time and the impact of regional rheumatologist supply in Ontario, Canada, 2002-2019. BMC Rheumatol 2022; 6:86. [PMID: 36572934 PMCID: PMC9793576 DOI: 10.1186/s41927-022-00315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/25/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To determine whether there were improvements in rheumatology care for rheumatoid arthritis (RA) between 2002 and 2019 in Ontario, Canada, and to evaluate the impact of rheumatologist regional supply on access. METHODS We conducted a population-based retrospective study of all individuals diagnosed with RA between January 1, 2002 and December 31, 2019. Performance measures evaluated were: (i) percentage of RA patients seen by a rheumatologist within one year of diagnosis; and (ii) percentage of individuals with RA aged 66 years and older (whose prescription drugs are publicly funded) dispensed a disease modifying anti-rheumatic drug (DMARD) within 30 days after initial rheumatologist visit. Logistic regression was used to assess whether performance improved over time and whether the improvements differed by rheumatology supply, dichotomized as < 1 rheumatologist per 75,000 adults versus ≥1 per 75,000. RESULTS Among 112,494 incident RA patients, 84% saw a rheumatologist within one year: The percentage increased over time (adjusted odds ratio (OR) 2019 vs. 2002 = 1.43, p < 0.0001) and was consistently higher in regions with higher rheumatologist supply (OR = 1.73, 95% CI 1.67-1.80). Among seniors who were seen by a rheumatologist within 1 year of their diagnosis the likelihood of timely DMARD treatment was lower among individuals residing in regions with higher rheumatologist supply (OR = 0.90 95% CI 0.83-0.97). These trends persisted after adjusting for other covariates. CONCLUSION While access to rheumatologists and treatment improved over time, shortcomings remain, particularly for DMARD use. Patients residing in regions with higher rheumatology supply were more likely to access care but less likely to receive timely treatment.
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Affiliation(s)
- Claire E. H. Barber
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Ruth Croxford
- grid.418647.80000 0000 8849 1617ICES, Toronto, Canada
| | - Cheryl Barnabe
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Deborah A. Marshall
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Michal Abrahamowicz
- Arthritis Research Canada, Vancouver, BC Canada ,grid.14709.3b0000 0004 1936 8649Department of Epidemiology and Biostatistics, McGill University, Montreal, QC Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, BC Canada ,grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - J. Antonio Avina-Zubieta
- Arthritis Research Canada, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - John M. Esdaile
- Arthritis Research Canada, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Glen Hazlewood
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Peter Faris
- grid.413574.00000 0001 0693 8815Alberta Health Services, Calgary, AB Canada
| | - Steven Katz
- grid.17089.370000 0001 2190 316XDepartment of Medicine, University of Alberta, Edmonton, AB Canada
| | - Paul MacMullan
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada
| | - Dianne Mosher
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada
| | - Jessica Widdifield
- grid.418647.80000 0000 8849 1617ICES, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Canada
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21
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Hazlewood GS, Pardo JP, Barnabe C, Schieir O, Barber CEH, Proulx L, Richards DP, Tugwell P, Bansback N, Akhavan P, Bombardier C, Bykerk V, Jamal S, Khraishi M, Taylor-Gjevre R, Thorne JC, Agarwal A, Pope JE. Canadian Rheumatology Association Living Guidelines for the Pharmacological Management of Rheumatoid Arthritis With Disease-Modifying Antirheumatic Drugs. J Rheumatol 2022; 49:1092-1099. [PMID: 35840155 DOI: 10.3899/jrheum.220209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To provide the initial installment of a living guideline that will provide up-to-date guidance on the pharmacological management of patients with rheumatoid arthritis (RA) in Canada. METHODS The Canadian Rheumatology Association (CRA) formed a multidisciplinary panel composed of rheumatologists, researchers, methodologists, and patients. In this first installment of our living guideline, the panel developed a recommendation for the tapering of biologic and targeted synthetic disease-modifying antirheumatic drug (b/ts DMARD) therapy in patients in sustained remission using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach, including a health equity framework developed for the Canadian RA population. The recommendation was adapted from a living guideline of the Australia & New Zealand Musculoskeletal Clinical Trials Network. RESULTS In people with RA who are in sustained low disease activity or remission for at least 6 months, we suggest offering stepwise reduction in the dose of b/tsDMARD without discontinuation, in the context of a shared decision, provided patients are able to rapidly access rheumatology care and reestablish their medications if needed. In patients where rapid access to care or reestablishing access to medications is challenging, we conditionally recommend against tapering. A patient decision aid was developed to complement the recommendation. CONCLUSION This living guideline will provide contemporary RA management recommendations for Canadian practice. New recommendations will be added over time and updated, with the latest recommendation, evidence summaries, and Evidence to Decision summaries available through the CRA website (www.rheum.ca).
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Affiliation(s)
- Glen S Hazlewood
- G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Professor, C.E.H. Barber, MD, PhD, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada;
| | - Jordi Pardo Pardo
- J. Pardo Pardo, Ldo, Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada
| | - Cheryl Barnabe
- G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Professor, C.E.H. Barber, MD, PhD, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Orit Schieir
- O. Schieir, PhD, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Claire E H Barber
- G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Professor, C.E.H. Barber, MD, PhD, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Laurie Proulx
- L. Proulx, B.Com, D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Dawn P Richards
- L. Proulx, B.Com, D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Peter Tugwell
- P. Tugwell, MD, Professor, Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Nick Bansback
- N. Bansback, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Pooneh Akhavan
- P. Akhavan, MD, MSc, Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Claire Bombardier
- C. Bombardier, MD, Professor, Division of Rheumatology, Mount Sinai Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vivian Bykerk
- V. Bykerk, MD, Professor, Hospital for Special Surgery, New York, New York, USA
| | - Shahin Jamal
- S. Jamal, MD, MSc, Clinical Associate Professor, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Majed Khraishi
- M. Khraishi, MD, Clinical Professor, Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada
| | - Regina Taylor-Gjevre
- R. Taylor-Gjevre, MD, MSc, Professor, Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - J Carter Thorne
- J.C. Thorne, MD, Assistant Professor, The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, Ontario, Canada
| | - Arnav Agarwal
- A. Agarwal, MD, Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Janet E Pope
- J.E. Pope, MD, MPH, Professor, Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada
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22
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Gukova X, Hazlewood GS, Arbillaga H, MacMullan P, Zimmermann GL, Barnabe C, Choi MY, Barber MRW, Charlton A, Job B, Osinski K, Hartfeld NMS, Knott MW, Pirani P, Barber CEH. Development of an interdisciplinary early rheumatoid arthritis care pathway. BMC Rheumatol 2022; 6:35. [PMID: 35751106 PMCID: PMC9233314 DOI: 10.1186/s41927-022-00267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background To develop an interdisciplinary care pathway for early rheumatoid arthritis (RA) including referral triage, diagnosis, and management. Methods Our process was a four-phase approach. In Phase 1, an anonymous survey was electronically distributed to division rheumatologists. This provided data to a small interprofessional working group of rheumatology team members who drafted an initial care pathway informed by evidence-based practice in Phase 2. In Phase 3, an education day was held with approximately 40 physicians (rheumatologists and rheumatology residents), members of our interprofessional team, and two clinic managers to review the proposed care elements through presentations and small group discussions. The care pathway was revised for content and implementation considerations based on feedback received. Implementation of the care pathway and development of strategies for evaluation is ongoing across multiple practice sites (Phase 4). Results Our care pathway promotes an approach to patient-centered early RA care using an interdisciplinary approach. Care pathway elements include triage processes, critical diagnostics, pre-treatment screening and vaccinations, and uptake of suggested RA pharmacologic treatment using shared decision-making strategies. Pathway implementation has been facilitated by nursing protocols and evaluation includes continuous monitoring of key indicators. Conclusion The ‘Calgary Early RA Care Pathway’ emphasizes a patient-centered and interdisciplinary approach to early RA identification and treatment. Implementation and evaluation of this care pathway is ongoing to support, highest quality care for patients. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00267-x.
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Affiliation(s)
- Xenia Gukova
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Arthritis Research Canada, Vancouver, Canada
| | - Hector Arbillaga
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | - Paul MacMullan
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | - Gabrielle L Zimmermann
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Learning Health System, Alberta SPOR SUPPORT Unit, Alberta, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Arthritis Research Canada, Vancouver, Canada
| | - May Y Choi
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada.,Arthritis Research Canada, Vancouver, Canada
| | - Megan R W Barber
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | | | - Becky Job
- Alberta Health Services, Calgary, Canada
| | | | - Nicole M S Hartfeld
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | | | | | - Claire E H Barber
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Arthritis Research Canada, Vancouver, Canada.
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23
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Barber CEH, Lacaille D, Croxford R, Barnabe C, Marshall DA, Abrahamowicz M, Xie H, Avina-Zubieta JA, Esdaile JM, Hazlewood G, Faris P, Katz S, MacMullan P, Mosher D, Widdifield J. A Population-Based Study Evaluating Retention in Rheumatology Care Among Patients With Rheumatoid Arthritis. ACR Open Rheumatol 2022; 4:613-622. [PMID: 35514156 PMCID: PMC9274367 DOI: 10.1002/acr2.11442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The study objective was to assess adherence to system‐level performance measures measuring retention in rheumatology care and disease modifying anti‐rheumatic drug (DMARD) treatment in rheumatoid arthritis (RA). Methods We used a validated health administrative data case definition to identify individuals with RA in Ontario, Canada, between 2002 and 2014 who had at least 5 years of potential follow‐up prior to 2019. During the first 5 years following diagnosis, we assessed whether patients were seen by a rheumatologist yearly and the proportion dispensed a DMARD yearly (in those aged ≥66 for whom medication data were available). Multivariable logistic regression analyses were used to estimate the odds of remaining under rheumatologist care. Results The cohort included 50,883 patients with RA (26.1% aged 66 years and older). Over half (57.7%) saw a rheumatologist yearly in all 5 years of follow‐up. Sharp declines in the percentage of patients with an annual visit were observed in each subsequent year after diagnosis, although a linear trend to improved retention in rheumatology care was seen over the study period (P < 0.0001). For individuals aged 66 years or older (n = 13,293), 82.1% under rheumatologist care during all 5 years after diagnosis were dispensed a DMARD annually compared with 31.0% of those not retained under rheumatology care. Older age, male sex, lower socioeconomic status, higher comorbidity score, and having an older rheumatologist decreased the odds of remaining under rheumatology care. Conclusion System‐level improvement initiatives should focus on maintaining ongoing access to rheumatology specialty care. Further investigation into causes of loss to rheumatology follow‐up is needed.
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Affiliation(s)
- Claire E H Barber
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Cheryl Barnabe
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Deborah A Marshall
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Michal Abrahamowicz
- Arthritis Research Canada, Vancouver, British Columbia, Canada, and McGill University, Montreal, Quebec, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver British Columbia, Canada, and Simon Fraser University, Burnaby, British Columbia, Canada
| | - J Antonio Avina-Zubieta
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - John M Esdaile
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Glen Hazlewood
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | | | - Steven Katz
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Jessica Widdifield
- ICES, University of Toronto, and Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Canada
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24
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Hazlewood GS, Loyola-Sanchez A, Bykerk V, Hull PM, Marshall D, Pham T, Barber CEH, Barnabe C, Sirois A, Pope J, Schieir O, Richards D, Proulx L, Bartlett SJ. Corrigendum to: Patient and Rheumatologist Perspectives on Tapering DMARDs in Rheumatoid Arthritis: A Qualitative Study. Rheumatology (Oxford) 2021; 60:5484. [PMID: 34532735 DOI: 10.1093/rheumatology/keab482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Glen S Hazlewood
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary.,Arthritis Research Canada, Richmond, BC.,McCaig Institute for Bone and Joint Health, Calgary
| | - Adalberto Loyola-Sanchez
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Vivian Bykerk
- Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Pauline M Hull
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary
| | - Deborah Marshall
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary.,Arthritis Research Canada, Richmond, BC.,McCaig Institute for Bone and Joint Health, Calgary
| | - Tram Pham
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary
| | - Claire E H Barber
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary.,Arthritis Research Canada, Richmond, BC.,McCaig Institute for Bone and Joint Health, Calgary
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary.,Arthritis Research Canada, Richmond, BC.,McCaig Institute for Bone and Joint Health, Calgary
| | - Alexandra Sirois
- Faculty of Graduate Studies, McGill University, Montreal, Quebec
| | - Janet Pope
- St. Joseph's Health Care London, University of Western Ontario, London
| | - Orit Schieir
- Dalla Lana School of Public Health, University of Toronto
| | - Dawn Richards
- Canadian Arthritis Patient Alliance, Toronto, Ontario
| | - Laurie Proulx
- Canadian Arthritis Patient Alliance, Toronto, Ontario
| | - Susan J Bartlett
- Division of Clinical Epidemiology, Department of Medicine, McGill University and Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
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25
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Tam K, Hazlewood GS, Barber CEH. Effect of Training on Patient Self-Assessment of Joint Counts in Rheumatoid Arthritis: A Systematic Review. ACR Open Rheumatol 2021; 3:860-869. [PMID: 34535968 PMCID: PMC8672172 DOI: 10.1002/acr2.11344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/16/2021] [Indexed: 11/11/2022] Open
Abstract
Objective Patient self‐assessed joint counts, if accurate and reliable, could potentially serve as a useful clinical assessment tool in rheumatoid arthritis (RA). This systematic review examines the effect of patient training on the inter‐rater reliability of joint counts between patients and clinicians. Methods The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A search was performed in PubMed, Embase, Cochrane Library, and CINAHL for articles that incorporated patient training and measured the reliability of patient self‐assessed joint counts in RA. Articles were included if they reported on the inter‐rater reliability between patient and clinician joint counts in both trained and untrained patients with RA. Data were extracted on characteristics of patients, structure and components of the training interventions, joint count reliability of patients with and without training, and patient feedback on training interventions. The relevant data were summarized and described. Results Multiple training methods have been studied (n = 5), including in‐person sessions run by rheumatologists and instructional videos on the joint examination. Overall, training improved the reliability of patient self–joint counts, with more marked improvement in reliability of swollen joint counts than tender joint counts. Patients had positive feedback when surveyed on their experiences with training. Conclusion Various training modalities (in‐person and video‐based) may be effective at improving reliability of patient self–joint counts. More research is needed on this topic, with potential areas for future research including 1) comparison between the efficacy of different modalities of training, and 2) impact of patient factors (education level and disease severity) on the efficacy of training.
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Affiliation(s)
- Keith Tam
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Glen S Hazlewood
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Claire E H Barber
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
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26
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Umaefulam V, Fox TL, Hazlewood G, Bansback N, Barber CEH, Barnabe C. Adaptation of a Shared Decision-Making Tool for Early Rheumatoid Arthritis Treatment Decisions with Indigenous Patients. Patient 2021; 15:233-243. [PMID: 34486098 PMCID: PMC8866334 DOI: 10.1007/s40271-021-00546-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/26/2022]
Abstract
Background Patient decision aids (PtDAs) enable shared decision-making between patients and healthcare providers. Adaptations to PtDAs for use with populations facing inequities in healthcare can improve the relevancy of information presented, incorporate appropriate cultural context, and address health literacy concerns. Our objective was to adapt the Early RA (rheumatoid arthritis) PtDA for use with Canadian Indigenous patients. Methods The Early RA PtDA was modified through an iterative process using data obtained from semi-structured interviews of two sequential cohorts of Indigenous patients with RA. Interview data were analyzed using thematic analysis. Results Seven participants provided initial feedback on the existing PtDA. The modifications they suggested were made and shared with another nine participants to confirm acceptability and provide further feedback. The first cohort suggested revisions to clarify medical and cost coverage information, include Indigenous traditional healing practice options, simplify text, and include Indigenous images and colors aligned with Canadian Indigenous community representation. Additional revisions were suggested by the second cohort to increase the legibility of the text, insert more Indigenous imagery, address formulary coverage for non-status First Nations patients, and include information about lifestyle factors in managing RA. Conclusion Incorporating Indigenous-specific adaptations in the design of PtDAs may increase use and relevancy to support engagement in treatment decisions, thereby supporting health-equity oriented health service interventions. Indigenous patient-specific evidence and translation of key words into the end-users’ Indigenous languages should be included for implementation of the PtDA. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00546-8.
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Affiliation(s)
- Valerie Umaefulam
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Nick Bansback
- Centre for Health Evaluation and Outcome Sciences at St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Arthritis Research Canada, Richmond, British Columbia, Canada.
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27
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Lee JJY, Laxer RM, Feldman BM, Barber CEH, Batthish M, Berard R, Tucker LB, Levy DM. Variations in Pediatric Rheumatology Workforce and Care Processes Across Canada. J Rheumatol 2021; 49:197-204. [PMID: 34334367 DOI: 10.3899/jrheum.201611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine Canadian pediatric rheumatology workforce and care processes. METHODS Pediatric rheumatologists and allied health professionals (AHPs) participated. A designee from each academic centre provided workforce information including number of providers, total and breakdown of full-time equivalents (FTE), and triage processes. We calculated the clinical care FTE (cFTE) available per 75,000 (recommended benchmark) and 300,000 (adjusted) children using 2019 census data. The national workforce deficit was calculated as the difference between current and expected cFTEs. Remaining respondents were asked about ambulatory practices. RESULTS The response rate of survey A (workforce information) and survey B (ambulatory practice information) was 100% and 54%, respectively. The majority of rheumatologists (91%) practiced in academic centres. The median number of rheumatologists per centre was 3 (IQR:3) and median cFTE was 1.8 (IQR:1.5). The median cFTE per 75,000 was 0.2 (IQR:0.3) with a national deficit of 80 cFTEs. With the adjusted benchmark, there was no national deficit but a regional maldistribution of rheumatologists. All centres engaged in multidisciplinary practices with a median of 4 different AHPs, although the median FTE for AHPs was ≤1. Most centres (87%) utilized a centralized triage process. Of 9 (60%) centres that used an electronic triage process, 6 were able to calculate wait times. Most clinicians integrated quality improvement practices, such as pre-visit planning (68%), post-visit planning (68%), and periodic health outcome monitoring (36-59%). CONCLUSION This study confirms a national deficit at the current recommended benchmark. Most rheumatologists work in multidisciplinary teams, but AHP support may be inadequate.
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Affiliation(s)
- Jennifer J Y Lee
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Ronald M Laxer
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Brian M Feldman
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Claire E H Barber
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Michelle Batthish
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Roberta Berard
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Lori B Tucker
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
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Hazlewood GS, Bombardier C, Li X, Movahedi M, Choquette D, Coupal L, Bykerk V, Schieir O, Mosher D, Marshall DA, Bernatsky S, Spencer N, Richards DP, Proulx L, Barber CEH. Heterogeneity in patient characteristics and differences in treatment across four Canadian rheumatoid arthritis cohorts. J Rheumatol 2021; 49:16-25. [PMID: 34334357 DOI: 10.3899/jrheum.201688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare clinical characteristics and treatment of patients with rheumatoid arthritis (RA) across 4 Canadian cohorts. METHODS The four longitudinal cohorts included: The Canadian Early Arthritis Cohort (CATCH) (n=2878); Ontario Best Practices Research Initiative (OBRI) (n=3734); RHUMADATA® (Quebec, n=2890), and the Rheum4U Precision Health Registry (Calgary, n=709). Data were from cohort inception (range 1998-2016) to 2020. Clinical characteristics and drug treatments were summarized descriptively. RESULTS 10,211 patients with RA were included. The percentage of patients who entered the cohort with early RA ( ≤ 2 years of disease at enrolment) ranged from 29% (Rheum4U) to 100% (CATCH). Mean age (55 years), sex (74% female) and seropositivity (69%) were similar between cohorts. At the time of initial disease modifying anti-rheumatic drug (DMARD) use, median disease activity scores (DAS-28) varied, ranging from 2.99 (Rheum4U) to 5.19 (CATCH), but were more similar at the time of the first DMARD switch (range:3.57-5.03), first biologic or targeted synthetic DMARD (bDAMRD, tsDMARD) use (range:4.01-4.67) and second bDAMRD or tsDMARD (range:3.71-4.39). The initial DMARD was most commonly methotrexate, either in monotherapy (32%, range:18%-40%) or dual therapy (34%, range:29%- 42%). The first DMARD switch was to another DMARD monotherapy in 20% (range:10%- 32%), dual therapy in 49% (range:39%-56%), and bDMARD or tsDMARD in 24% (range:15%- 28%). The first bDMARD was an anti-TNF in 79% (range:78%-85%). CONCLUSION Canadian RA cohorts demonstrate some heterogeneity in treatment which could reflect differences in inclusion criteria, calendar year, or regional differences. This project is a first step towards conducting harmonized analyses across Canadian RA cohorts.
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Affiliation(s)
- Glen S Hazlewood
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Claire Bombardier
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Xiuying Li
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Mohammad Movahedi
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Denis Choquette
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Louis Coupal
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Vivian Bykerk
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Orit Schieir
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Dianne Mosher
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Deborah A Marshall
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Sasha Bernatsky
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Nicole Spencer
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Dawn P Richards
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Laurie Proulx
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
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Lopatina E, Marshall DA, Le Clercq SA, Noseworthy TW, Suter E, De la Rossa Jaimes C, Lauf AM, Mosher DP, Barber CEH. Nurse-Led Care for Stable Patients with Rheumatoid Arthritis: Quality of Care in Routine Practice Compared to the Traditional Rheumatologist-Led Model. Rheumatol Ther 2021; 8:1263-1285. [PMID: 34236650 PMCID: PMC8380599 DOI: 10.1007/s40744-021-00339-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/16/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction This pragmatic non-inferiority study assessed quality of care within a nurse-led care (NLC) model for stable patients with rheumatoid arthritis (RA) compared to the traditional rheumatologist-led care (RLC) model. Methods Data were collected through a chart review. Baseline demographic and clinical characteristics were compared using Chi-square test and t test. The primary outcome measure was the percentage of patients being in remission or low disease activity (R/LDA) with the Disease Activity Score (DAS-28) ≤ 3.2 at 1-year follow-up. Process measures included the percentages of patients with chart documentation of (1) comorbidity screening; (2) education on flare management, and (3) vaccinations screening. Outcomes were summarized using descriptive statistics. Results Each group included 124 patients. At baseline, demographic and clinical characteristics were comparable between the groups for most variables. Exceptions were the median (Q1, Q3) Health Assessment Questionnaire Disability Index scores [0 (0, 0.25) in NLC and 0.38 (0, 0.88) in RLC, p = 0.01], and treatment patterns with 3% of NLC and 38% of RLC patients receiving a biologic agent, p = 0.01. NLC was non-inferior to RLC with 97% of NLC and 92% of RLC patients being in R/LDA at 1-year follow-up. Patients in the NLC group had better documentation across all process measures. Conclusions This study provided real-world evidence that the evaluated NLC model providing protocolized follow-up care for stable patients with RA is effective to address patients’ needs for ongoing disease monitoring, chronic disease management, education, and support. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00339-3.
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Affiliation(s)
- Elena Lopatina
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3C60, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3C56, 3280 Hospital Drive NW , Calgary, AB, T2N 4Z6, Canada.
| | - Sharon A Le Clercq
- Department of Medicine, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3C60, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Tom W Noseworthy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Teaching, Research, and Wellness Building (TRW), 3D14-B, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Esther Suter
- Faculty of Social Work, University of Calgary, Health Research Innovation Centre (HRIC), 3C60, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Carolina De la Rossa Jaimes
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3C60, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Anne Marie Lauf
- Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3C60, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Dianne P Mosher
- Department of Medicine, Cumming School of Medicine, University of Calgary, Health Sciences Centre (HSC), G-802A, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3AA20, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3AA20, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
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Barber CEH, Marshall DA, Szefer E, Barnabe C, Shiff NJ, Bykerk V, Homik J, Thorne JC, Ahluwalia V, Benseler S, Mosher D, Twilt M, Lacaille D. A Population-Based Approach to Reporting System-Level Performance Measures for Rheumatoid Arthritis Care. Arthritis Care Res (Hoboken) 2021; 73:640-648. [PMID: 32144843 DOI: 10.1002/acr.24178] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/25/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To operationalize and report on nationally endorsed rheumatoid arthritis (RA) performance measures (PMs) using health administrative data for British Columbia (BC), Canada. METHODS All patients with RA in BC ages ≥18 years were identified between January 1, 1997 and December 31, 2009 using health administrative data and followed until December 2014. PMs tested include: the percentage of incident patients with ≥1 rheumatologist visit within 365 days; the percentage of prevalent patients with ≥1 rheumatologist visit per year; the percentage of prevalent patients dispensed disease-modifying antirheumatic drug (DMARD) therapy; and time from RA diagnosis to DMARD therapy. Measures were reported on patients seen by rheumatologists, and in the total population. RESULTS The cohort included 38,673 incident and 57,922 prevalent RA cases. The percentage of patients seen by a rheumatologist within 365 days increased over time (35% in 2000 to 65% in 2009), while the percentage of RA patients under the care of a rheumatologist seen yearly declined (79% in 2001 to 39% in 2014). The decline was due to decreasing visit rates with increasing follow-up time rather than calendar effect. The percentage of RA patients dispensed a DMARD was suboptimal over follow-up (37% in 2014) in the total population but higher (87%) in those under current rheumatologist care. The median time to DMARD in those seen by a rheumatologist improved from 49 days in 2000 to 23 days in 2009, with 34% receiving treatment within the 14-day benchmark. CONCLUSION This study describes the operationalization and reporting of national PMs using administrative data and identifies gaps in care to further examine and address.
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Affiliation(s)
- Claire E H Barber
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Deborah A Marshall
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | | | - Cheryl Barnabe
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | | | - Vivian Bykerk
- Hospital for Special Surgery and Cornell University, New York, New York
| | - Joanne Homik
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Susanne Benseler
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | | | - Marinka Twilt
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Richmond, and University of British Columbia, Vancouver, British Columbia, Canada
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Hazlewood GS, Pardo JP, Barnabe C, Schieir O, Barber CEH, Bernatsky S, Colmegna I, Hitchon C, Loeb M, Mertz D, Proulx L, Richards DP, Scuccimarri R, Tugwell P, Schünemann HJ, Mirza RD, Zhou AL, Nikolic RPA, Thomas M, Chase H, Ejaredar M, Nieuwlaat R. Canadian Rheumatology Association Recommendation for the Use of COVID-19 Vaccination for Patients With Autoimmune Rheumatic Diseases. J Rheumatol 2021; 48:1330-1339. [PMID: 33993119 DOI: 10.3899/jrheum.210288] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To develop guidance on the use of coronavirus disease 2019 (COVID-19) vaccines in patients with autoimmune rheumatic diseases (ARD). METHODS The Canadian Rheumatology Association (CRA) formed a multidisciplinary panel including rheumatologists, researchers, methodologists, vaccine experts, and patients. The panel used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Outcomes were prioritized according to their importance for patients and clinicians. Evidence from the COVID-19 clinical trials was summarized. Indirect evidence for non-COVID-19 vaccines in ARD was also considered. The GRADE evidence-to-decision (EtD) framework was used to develop a recommendation for the use of the 4 COVID-19 vaccines approved in Canada as of March 25, 2021 (BNT162b2, mRNA-1273, ChAdOx1, and Ad26.COV2.S), over 4 virtual panel meetings. RESULTS The CRA guideline panel suggests using COVID-19 vaccination in persons with ARD. The panel unanimously agreed that for the majority of patients, the potential health benefits of vaccination outweigh the potential harms in people with ARDs. The recommendation was graded as conditional because of low or very low certainty of the evidence on the effects in the population of interest, primarily due to indirectness and imprecise effect estimates. The panel felt strongly that persons with autoimmune rheumatic diseases who meet local eligibility should not be required to take additional steps compared to people without ARDs to obtain their vaccination. Guidance on medications, implementation, monitoring of vaccine uptake, and research priorities are also provided. CONCLUSION This recommendation will be updated over time as new evidence emerges, with the latest recommendation, evidence summaries, and EtD available on the CRA website.
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Affiliation(s)
- Glen S Hazlewood
- G.S. Hazlewood, MD, PhD, Associate Professor of Medicine, C. Barnabe, MD, MSc, Associate Professor of Medicine, C.E. Barber, MD, PhD, Assistant Professor of Medicine, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, and Arthritis Research Canada, Richmond, British Columbia;
| | - Jordi Pardo Pardo
- J.P. Pardo, LDO, Managing Editor, Centre for Global Health, University of Ottawa, Ottawa, Ontario
| | - Cheryl Barnabe
- G.S. Hazlewood, MD, PhD, Associate Professor of Medicine, C. Barnabe, MD, MSc, Associate Professor of Medicine, C.E. Barber, MD, PhD, Assistant Professor of Medicine, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, and Arthritis Research Canada, Richmond, British Columbia
| | - Orit Schieir
- O. Schieir, PhD, Canadian Early Arthritis Cohort Study, Toronto, Ontario
| | - Claire E H Barber
- G.S. Hazlewood, MD, PhD, Associate Professor of Medicine, C. Barnabe, MD, MSc, Associate Professor of Medicine, C.E. Barber, MD, PhD, Assistant Professor of Medicine, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, and Arthritis Research Canada, Richmond, British Columbia
| | - Sasha Bernatsky
- S. Bernatsky, MD, PhD, Professor of Medicine, Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec
| | - Ines Colmegna
- I. Colmegna, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, McGill University, Montreal, Quebec
| | - Carol Hitchon
- C. Hitchon, MD, MSc, Associate Professor of Medicine, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Mark Loeb
- M. Loeb, MD, MSc, Professor, D. Mertz, MD, MSc, Associate Professor of Medicine, H.J. Schünemann, MD, MSc, PhD, Professor of Medicine and Clinical Epidemiology, Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster GRADE Centers, Hamilton
| | - Dominik Mertz
- M. Loeb, MD, MSc, Professor, D. Mertz, MD, MSc, Associate Professor of Medicine, H.J. Schünemann, MD, MSc, PhD, Professor of Medicine and Clinical Epidemiology, Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster GRADE Centers, Hamilton
| | - Laurie Proulx
- L. Proulx, B.Com, D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario
| | - Dawn P Richards
- L. Proulx, B.Com, D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario
| | - Rosie Scuccimarri
- R. Scuccimarri, MD, Associate Professor of Pediatrics, Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec
| | - Peter Tugwell
- P. Tugwell, MD, Professor of Medicine, A.L. Zhou, MD, Department of Medicine, University of Ottawa, Ottawa, Ontario
| | - Holger J Schünemann
- M. Loeb, MD, MSc, Professor, D. Mertz, MD, MSc, Associate Professor of Medicine, H.J. Schünemann, MD, MSc, PhD, Professor of Medicine and Clinical Epidemiology, Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster GRADE Centers, Hamilton
| | - Reza D Mirza
- R.D. Mirza, MD, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Alan L Zhou
- P. Tugwell, MD, Professor of Medicine, A.L. Zhou, MD, Department of Medicine, University of Ottawa, Ottawa, Ontario
| | - Roko P A Nikolic
- R.P. Nikolic, BSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Megan Thomas
- M. Thomas, BHSc, M. Ejaredar, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | | | - Maede Ejaredar
- M. Thomas, BHSc, M. Ejaredar, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Robby Nieuwlaat
- R. Nieuwlaat, MSc, PhD, Associate Professor, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Liu X, Barber CEH, Katz S, Homik J, Bertazzon S, Patel AB, Robert J, Smith C, Mosher D, Marshall DA. Geographic Variation in the Prevalence of Rheumatoid Arthritis in Alberta, Canada. ACR Open Rheumatol 2021; 3:324-332. [PMID: 33793090 PMCID: PMC8126758 DOI: 10.1002/acr2.11251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Timely access to rheumatologists remains a challenge in Alberta, a Canadian province with vast rural areas, whereas rheumatologists are primarily clustered in metro areas. To address the goal of timely and equitable access to rheumatoid arthritis (RA) care, health planners require information at the regional and local level to determine the RA prevalence and the associated health care needs. METHODS Using Alberta Health administrative databases, we identified RA-prevalent cases (April 1, 2015-March 31, 2016) on the basis of a validated case definition. Age- and sex-standardized prevalence rates per 1000 population members and the standardized rates ratio (SRR) were calculated. We applied Global Moran's I and Gi* hotspot analysis using three different weight matrices to explore the geospatial pattern of RA prevalence in Alberta. RESULTS Among 38 350 RA cases (68% female; n = 26 236), the prevalence rate was 11.81 cases per 1000 population members (95% confidence interval [CI] 11.80-11.81) after age and sex standardization. Approximately 60% of RA cases resided in metro (Calgary and Edmonton) and moderate metro areas. The highest rate was observed in rural areas (14.46; 95% CI 14.45-14.47; SRR 1.28), compared with the lowest in metro areas (10.69; 95% CI 10.68-10.69; SRR 0.82). The RA prevalence across local geographic areas ranged from 4.7 to 30.6 cases. The Global Moran's I index was 0.15 using three different matrices (z-score 3.96-4.24). We identified 10 hotspots in the south and north rural areas and 18 cold spots in metro and moderate metro Calgary. CONCLUSION The findings highlight notable rural-urban variation in RA prevalence in Alberta. Our findings can inform strategies aimed at reducing geographic disparities by targeting areas with high health care needs.
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Affiliation(s)
| | - Claire E. H. Barber
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research CanadaRichmondBritish ColumbiaCanada
| | | | | | | | - Alka B. Patel
- University of Calgary, Calgary, Alberta, Canada, and Alberta Health ServicesEdmontonAlbertaCanada
| | - Jill Robert
- Alberta Health ServicesEdmontonAlbertaCanada
| | | | | | - Deborah A. Marshall
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research CanadaRichmondBritish ColumbiaCanada
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Hazlewood GS, Loyola-Sanchez A, Bykerk V, Hull PM, Marshall D, Pham T, Barber CEH, Barnabe C, Sirois A, Pope J, Schieir O, Richards D, Proulx L, Bartlett SJ. Patient and Rheumatologist Perspectives on Tapering DMARDs in Rheumatoid Arthritis: A Qualitative Study. Rheumatology (Oxford) 2021; 61:606-616. [PMID: 33878168 DOI: 10.1093/rheumatology/keab330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/06/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To understand the perspectives of patients and rheumatologists for tapering DMARDs in RA. METHODS Using semi-structured interview guides, we conducted individual interviews and focus groups with RA patients and rheumatologists, which were audiotaped and transcribed. We conducted a pragmatic thematic analysis to identify major themes, comparing and contrasting different views on DMARD tapering between patients and rheumatologists. RESULTS We recruited 28 adult patients with RA (64% women; disease duration 1-54 years) and 23 rheumatologists (52% women). Attitudes across both groups towards tapering DMARDs were ambivalent, ranging from wary to enthusiastic. Both groups expressed concerns, particularly the inability to 'recapture' the same level of disease control, while also acknowledging potential positive outcomes such as reduced drug harms. Patient tapering perspectives (whether to and when) changed over time and commonly included non-biologic DMARDs. Patient preferences were influenced by lived experiences, side effects, previous tapering experiences, disease trajectory, remission duration, and current life roles. Rheumatologists' perspectives varied on timing and patient profile to initiate tapering, and were informed by both data and clinical experience. Patients expressed interest in shared decision making (SDM) and close monitoring during tapering, with ready access to their healthcare team if problems arose. Rheumatologists were generally open to tapering (not stopping), though sometimes only when requested by their patients. CONCLUSION The perspectives of patients and rheumatologists on tapering DMARDs in RA vary and evolve over time. Rheumatologists should periodically discuss DMARD tapering with patients as part of SDM, and ensure monitoring and flare management plans are in place.
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Affiliation(s)
- Glen S Hazlewood
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Arthritis Research Canada, Richmond, BC, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Canada
| | - Adalberto Loyola-Sanchez
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Vivian Bykerk
- Hospital for Special Surgery, Weill Cornell Medical College, New York New York, USA
| | - Pauline M Hull
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Deborah Marshall
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Arthritis Research Canada, Richmond, BC, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Canada
| | - Tram Pham
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Claire E H Barber
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Arthritis Research Canada, Richmond, BC, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Canada
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Arthritis Research Canada, Richmond, BC, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Canada
| | - Alexandra Sirois
- Faculty of Graduate Studies, McGill University, Montreal, Quebec, Canada
| | - Janet Pope
- St. Joseph's Health Care London, University of Western Ontario, London, Ontario, Canada
| | - Orit Schieir
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dawn Richards
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Laurie Proulx
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Susan J Bartlett
- Division of Clinical Epidemiology, Department of Medicine, McGill University and Centre for Outcomes Research and Evaluation, Research Institute-McGill University Health Centre, Montreal, Quebec, Canada
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Barber CEH, Spencer N, Bansback N, Zimmermann GL, Li LC, Richards DP, Proulx L, Mosher DP, Hazlewood GS. Development of an Implementation Strategy for Patient Decision Aids in Rheumatoid Arthritis Through Application of the Behavior Change Wheel. ACR Open Rheumatol 2021; 3:312-323. [PMID: 33793083 PMCID: PMC8126755 DOI: 10.1002/acr2.11250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Decision aids are being developed to support guideline-based rheumatology care in Canada. The study objective was to identify barriers to decision aid use in rheumatoid arthritis (RA) within a behavior change model to inform an implementation strategy. METHODS Perspectives from Canadian health care providers (HCPs) and patients living with RA were obtained on an early RA decision aid and on perceived facilitators and barriers to decision aid implementation. Data were collected through semistructured interviews, transcribed, and then analyzed by inductive thematic analysis. The lessons learned were then mapped to the behavior change wheel COM-B system (C = capability, O = opportunity, and M = motivation interact to influence B = behavior) to inform key elements of a national implementation strategy. RESULTS Fifteen HCPs and fifteen patients participated. The analysis resulted in five lessons learned: 1) paternalistic decision-making is a dominant practice in early RA, 2) patients need emotional support and access to educational tools to facilitate participation in shared decision-making (SDM), 3) there are many logistical barriers to decision aid implementation in current care models, 4) flexibility is necessary for successful implementation, and 5) HCPs have limited interest in further training opportunities about decision aids. Implementation recommendations included the following: 1) making the decision aids directly available to patients (O) and providing SDM education (C/M), 2) creating an SDM rheumatology curriculum (C/O/M), 3) using "decision coaches" or patient partners as peer support (C/O/M), 4) linking decision aids to "living" rheumatology guidelines (M), and 5) designing trials of patient decision aid/SDM interventions to evaluate patient-important outcomes (O/M). CONCLUSION A multifaceted strategy is suggested to improve uptake of decision aids.
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Affiliation(s)
- Claire E H Barber
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | | | - Nick Bansback
- Centre for Health Evaluation and Outcome Sciences at St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Gabrielle L Zimmermann
- Alberta Strategy for Patient Oriented Research (SPOR) SUPPORT Unit, University of Alberta, Edmonton, Alberta, Canada, and University of Calgary, Calgary, Alberta, Canada
| | - Linda C Li
- University of British Columbia, Vancouver, British Columbia, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | | | | | | | - Glen S Hazlewood
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
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Han L, Hazlewood GS, Barnabe C, Barber CEH. Systematic Review of Outcomes and Patient Experience with Virtual Care in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2021; 74:1484-1492. [PMID: 33650316 DOI: 10.1002/acr.24586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/06/2021] [Accepted: 02/25/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To conduct a systematic review on patient outcomes of virtual care compared to conventional care in rheumatoid arthritis (RA) including disease activity and patient experience. METHODS A systematic search of MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials was performed from database inception to 03/19/2020. Observational and randomized controlled trials (RCTs) describing the use of RA virtual care supplanting conventional visits and reporting on disease activity and/or patient experience were included. A narrative synthesis of results was conducted as a meta-analysis was not possible due to heterogeneity of study designs and outcome reporting. RESULTS 352 studies were identified, and 6 were selected for final inclusion: 3 were RCTs and 3 were observational studies. Disease activity and patient experience were comparable between virtual and conventional care models. In addition, one RCT found no difference in observed outcomes between virtual care delivered by a rheumatologist and by a rheumatology nurse. Virtual care was found to have additional benefits for improved treatment adherence, maintenance of functional status, and quality of life. The overall risk of bias was low in 2/3 RCTs, but high in the observational studies. Study quality was limited by incomplete data reporting, lack of sample size justification and sufficient timeframe to assess objectives. CONCLUSIONS There is limited evidence that virtual RA care is an acceptable alternative to conventional care, maintaining comparable patient outcomes and experience of care. Additional research into effective implementation strategies and long-term health system and patient outcomes of virtual care are needed. SIGNIFICANCE AND INNOVATIONS There is a paucity of research in the use of virtual care for rheumatology, especially describing the ability of virtual care modalities to supplant in person visits. Virtual care for rheumatoid arthritis (RA) management appears in the short term to provide equivalent control of disease activity and good patient experience compared to conventional follow-up strategies. Future studies should evaluate the long-term impacts of virtual care on RA outcomes and health service utilization.
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Affiliation(s)
- Lily Han
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Glen S Hazlewood
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Arthritis Research, Canada
| | - Chery Barnabe
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Arthritis Research, Canada
| | - Claire E H Barber
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Arthritis Research, Canada
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Widdifield J, Bernatsky S, Pope JE, Kuriya B, Barber CEH, Eder L, Ahluwalia V, Ling V, Gozdyra P, Hofstetter C, Lyddiatt A, Paterson JM, Thorne C. Evaluation of Rheumatology Workforce Supply Changes in Ontario, Canada, from 2000 to 2030. ACTA ACUST UNITED AC 2021; 16:119-134. [PMID: 33720829 PMCID: PMC7957360 DOI: 10.12927/hcpol.2021.26428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rheumatology workforces are increasingly challenged by too few physicians in face of the growing burden of rheumatic and musculoskeletal diseases (RMDs). Rheumatology is one of the most frequent non-surgical specialty referrals and has the longest wait times for subspecialists. We used a population-based approach to describe changes in the rheumatology workforce, patient volumes and geographic variation in the supply of and access to rheumatologists, in Ontario, Canada, between 2000 and 2019, and projected changes in supply by 2030. Over time, we observed greater feminization of the workforce and increasing age of workforce members. We identified a large regional variation in rheumatology supply. Fewer new patients are seen annually, which likely contributes to increasing wait times and reduced access to care. Strategies and policies to raise the critical mass and improve regional distribution of supply to effectively provide rheumatology care and support the healthcare delivery of patients with RMDs are needed.
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Affiliation(s)
- Jessica Widdifield
- Scientist, Sunnybrook Research Institute Holland Bone & Joint Program; Assistant Professor, University of Toronto, Institute of Health Policy, Management & Evaluation Toronto, ON; Scientist, ICES Toronto, ON
| | - Sasha Bernatsky
- Rheumatologist and Scientist, Research Institute of the McGill University Health Centre; Associate Professor, Department of Epidemiology, McGill University, Montreal, QC
| | - Janet E Pope
- Rheumatologist, St Joseph's Health Care London; Professor of Medicine Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University London, ON
| | - Bindee Kuriya
- Rheumatologist, Sinai Health System; Assistant Professor, Department of Medicine, University of Toronto, Toronto, ON
| | - Claire E H Barber
- Rheumatologist, Assistant Professor, University of Calgary, Calgary, AB; Research Scientist, Arthritis Research Canada, Richmond, BC
| | - Lihi Eder
- Rheumatologist, Clinician Scientist, Women's College Research Institute, Toronto, ON
| | | | | | | | | | | | - J Michael Paterson
- Scientist, ICES, Toronto, ON; Assistant Professor, Department of Family Medicine, McMaster University, Hamilton, ON; Assistant Professor, University of Toronto, Institute of Health Policy, Management & Evaluation, Toronto, ON
| | - Carter Thorne
- Rheumatologist, Southlake Regional Health Centre, Newmarket, ON; Assistant Professor of Medicine, University of Toronto, Toronto, ON
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Widdifield J, Gatley JM, Pope JE, Barber CEH, Kuriya B, Eder L, Thorne C, Ling V, Paterson JM, Ahluwalia V, Marks C, Bernatsky S. Feminization of the Rheumatology Workforce: A Longitudinal Evaluation of Patient Volumes, Practice Sizes, and Physician Remuneration. J Rheumatol 2020; 48:1090-1097. [PMID: 33262302 DOI: 10.3899/jrheum.201166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare differences in clinical activity and remuneration between male and female rheumatologists and to evaluate associations between physician gender and practice sizes and patient volume, accounting for rheumatologists' age, and calendar year effects. METHODS We conducted a population-based study in Ontario, Canada, between 2000 to 2015 identifying all rheumatologists practicing as full-time equivalents (FTEs) or above and assessed differences in practice sizes (number of unique patients), practice volumes (number of patient visits), and remuneration (total fee-for-service billings) between male and female rheumatologists. Multivariable linear regression was used to evaluate the effects of gender on practice size and volume separately, accounting for age and year. RESULTS The number of rheumatologists practicing at ≥ 1 FTE increased from 89 to 120 from 2000 to 2015, with the percentage of females increasing from 27.0% to 41.7%. Males had larger practice sizes and practice volumes. Remuneration was consistently higher for males (median difference of CAD $46,000-102,000 annually). Our adjusted analyses estimated that in a given year, males saw a mean of 606 (95% CI 107-1105) more patients than females did, and had 1059 (95% CI 345-1773) more patient visits. Among males and females combined, there was a small but statistically significant reduction in mean annual number of patient visits, and middle-aged rheumatologists had greater practice sizes and volumes than their younger/older counterparts. CONCLUSION On average, female rheumatologists saw fewer patients and had fewer patient visits annually relative to males, resulting in lower earnings. Increasing feminization necessitates workforce planning to ensure that populations' needs are met.
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Affiliation(s)
- Jessica Widdifield
- J. Widdifield, PhD, ICES, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto, and Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario;
| | - Jodi M Gatley
- J.M. Gatley, MPH, V. Ling, MSc, ICES, Toronto, Ontario
| | - Janet E Pope
- J. E. Pope, MD, MPH, Division of Rheumatology, Western University, Schulich School of Medicine & Dentistry, and St Joseph's Health Care, London, Ontario
| | - Claire E H Barber
- C.E. Barber, MD, PhD, The Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada
| | - Bindee Kuriya
- B. Kuriya, MD, SM, Division of Rheumatology, University of Toronto, and Sinai Health System, Toronto, Ontario
| | - Lihi Eder
- L. Eder, MD, PhD, Women's College Research Institute, and University of Toronto, Toronto, Ontario
| | - Carter Thorne
- C. Thorne, MD, Department of Medicine, University of Toronto, Toronto, and Southlake Regional Health Centre, Newmarket, Ontario
| | - Vicki Ling
- J.M. Gatley, MPH, V. Ling, MSc, ICES, Toronto, Ontario
| | - J Michael Paterson
- J.M. Paterson, MSc, ICES, Toronto, and McMaster University, Department of Family Medicine, Hamilton, and Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario
| | | | - Courtney Marks
- C. Marks, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto, Ontario
| | - Sasha Bernatsky
- S. Bernatsky, MD, PhD, Department of Epidemiology, McGill University, and Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
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Barber CEH, Mosher D, Dowling S, Bohm V, Solbak NM, MacMullan P, Pan B, Barnabe C, Hazlewood GS, Then KL, Marshall DA, Rankin JA, Li LC, Tsui K, English K, Homik J, Spencer N, Hall M, Lacaille D. Implementation and Evaluation of Audit and Feedback for Monitoring Treat-to-Target (T2T) Strategies in Rheumatoid Arthritis Using Performance Measures. Rheumatol Ther 2020; 7:909-925. [PMID: 33034861 PMCID: PMC7695654 DOI: 10.1007/s40744-020-00237-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/16/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION In collaboration with the Alberta Medical Association's Physician Learning Program we developed individualized physician reports and held a group feedback session on rheumatoid arthritis (RA) performance measures (PM) to facilitate treat-to-target (T2T) strategies and evaluated physician experiences with this process. METHODS 5 PMs addressing T2T concepts from an established Canadian quality framework were operationalized for physician practice reports at 2 university-affiliated rheumatology clinics. Rheum4U, a quality improvement and research platform, was the data source. The audit results were reviewed in a facilitated group feedback session. Rheumatologists provided experiential feedback on the process through survey and/or an interview. Transcripts from interviews were analyzed using a 6-step thematic analysis. RESULTS 11 of 12 eligible rheumatologists consented to receive practice reports and provided feedback through surveys (n = 5) and interviews (n = 6). The practice reports from Rheum4U (n = 448 patients) revealed high rates of yearly follow-up (> 85%, PM1) and 100% performance on documentation of disease activity at ≥ 50% of visits (PM2). Only 34% of patients were seen within 3 months if not in remission (PM3) with 62% (2017) and 69% (2018) of those with active RA achieving a LDA state within 6 months (PM4). Approximately 70% of patients were in remission at any time point (PM5). All survey respondents agreed or strongly agreed comparison to peers was valuable and helped them reflect on their practice. Several strategies for improvement were identified, including but not limited to, leveraging of electronic records for future audit and feedback reports, providing additional granularity of results, additional stratification of results, and using high-performing peers as the comparator rather than the group mean. CONCLUSIONS Audit and feedback was perceived by clinicians as a useful strategy for evaluating T2T efforts in RA. Future work will focus on longitudinal evaluation of the clinical impact of this quality improvement initiative.
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Affiliation(s)
- Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Arthritis Research Canada, Richmond, BC, Canada.
| | - Dianne Mosher
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shawn Dowling
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Victoria Bohm
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nathan M Solbak
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul MacMullan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bo Pan
- Epidemiology Coordinating and Research Centre (EPICORE), Edmonton, AB, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Arthritis Research Canada, Richmond, BC, Canada
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Arthritis Research Canada, Richmond, BC, Canada
| | - Karen L Then
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Arthritis Research Canada, Richmond, BC, Canada
| | - James A Rankin
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Linda C Li
- Arthritis Research Canada, Richmond, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Karen Tsui
- Arthritis Patient Advisory Board, Richmond, BC, Canada
| | - Kelly English
- Arthritis Patient Advisory Board, Richmond, BC, Canada
| | - Joanne Homik
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Nicole Spencer
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marc Hall
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Richmond, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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Barber CEH, Lacaille D, Hall M, Bohm V, Li LC, Barnabe C, Hazlewood GS, Marshall DA, Rankin JA, Tsui K, English K, MacMullan P, Homik J, Mosher D, Then KL. Priorities for High-quality Care in Rheumatoid Arthritis: Results of Patient, Health Professional, and Policy Maker Perspectives. J Rheumatol 2020; 48:486-494. [PMID: 33191276 DOI: 10.3899/jrheum.201044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To elucidate the essential elements of high-quality rheumatoid arthritis (RA) care in order to develop a vision statement and a set of strategic objectives for a national RA quality framework. METHODS Focus groups and interviews were conducted by experienced qualitative researchers using a semistructured interview or focus group guide with healthcare professionals, patients, clinic managers, healthcare leaders, and policy makers to obtain their perspectives on elements essential to RA care. Purposive sampling provided representation of stakeholder types and regions. Recorded data was transcribed verbatim. Two teams of 2 coders independently analyzed the deidentified transcripts using thematic analysis. Strategic objectives and the vision statement were drafted based on the overarching themes from the qualitative analysis and finalized by a working group. RESULTS A total of 54 stakeholders from 9 Canadian provinces participated in the project (3 focus groups and 19 interviews). Seven strategic objectives were derived from the qualitative analysis representing the following themes: (1) early access and timeliness of care; (2) evidence-informed, high-quality care for the ongoing management of RA and comorbidities; (3) availability of patient self-management tools and educational materials for shared decision making; (4) multidisciplinary care; (5) patient outcomes; (6) patient experience and satisfaction with care; and (7) equity, the last of which emerged as an overarching theme. The ultimate vision obtained was "ensuring patient-centered, high-quality care for people living with rheumatoid arthritis." CONCLUSION The 7 strategic objectives that were identified highlight priorities for RA quality of care to be used in developing the National RA Quality Measurement Framework.
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Affiliation(s)
- Claire E H Barber
- C.E. Barber, MD, PhD, FRCPC, Assistant Professor, G.S. Hazlewood, MD, PhD, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, and Research Scientist, Arthritis Research Canada;
| | - Diane Lacaille
- D. Lacaille, MD, FRCPC, MHSc, Mary Pack Chair in Arthritis Research, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, and Scientific Director, Arthritis Research Canada
| | - Marc Hall
- M. Hall, MSc, CCRP, Research Associate, J.A. Rankin ACNP, PhD, Professor, K. Then, ACNP, CCN(C), PhD, Professor, Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Victoria Bohm
- V. Bohm, MSc, MPH, P. MacMullan, MBBCh, BAO, MRCPI, MD, Clinical Associate Professor, Rheumatology Division Head, D. Mosher MD, FRCPC, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Linda C Li
- L.C. Li, PT, PhD, Professor, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, and Senior Research Scientist, Arthritis Research Canada
| | - Cheryl Barnabe
- C. Barnabe, MD, MSc, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, and Senior Scientist, Arthritis Research Canada
| | - Glen S Hazlewood
- C.E. Barber, MD, PhD, FRCPC, Assistant Professor, G.S. Hazlewood, MD, PhD, FRCPC, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, and Research Scientist, Arthritis Research Canada
| | - Deborah A Marshall
- D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, Calgary, Alberta, and Senior Research Scientist, Arthritis Research Canada
| | - James A Rankin
- M. Hall, MSc, CCRP, Research Associate, J.A. Rankin ACNP, PhD, Professor, K. Then, ACNP, CCN(C), PhD, Professor, Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Karen Tsui
- K. Tsui, MScPT, ACPAC, K. English, Arthritis Patient Advisory Board (APAB)
| | - Kelly English
- K. Tsui, MScPT, ACPAC, K. English, Arthritis Patient Advisory Board (APAB)
| | - Paul MacMullan
- V. Bohm, MSc, MPH, P. MacMullan, MBBCh, BAO, MRCPI, MD, Clinical Associate Professor, Rheumatology Division Head, D. Mosher MD, FRCPC, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Joanne Homik
- J. Homik, MD, MSc, FRCPC, Professor, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. The authors declare no conflicts of interest
| | - Dianne Mosher
- V. Bohm, MSc, MPH, P. MacMullan, MBBCh, BAO, MRCPI, MD, Clinical Associate Professor, Rheumatology Division Head, D. Mosher MD, FRCPC, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Karen L Then
- M. Hall, MSc, CCRP, Research Associate, J.A. Rankin ACNP, PhD, Professor, K. Then, ACNP, CCN(C), PhD, Professor, Faculty of Nursing, University of Calgary, Calgary, Alberta
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Barnabe C, Chomistek K, Luca N, Hazlewood G, Barber CEH, Steiman A, Stringer E. National Priorities for High-quality Rheumatology Transition Care for Youth in Canada. J Rheumatol 2020; 48:426-433. [PMID: 33060318 DOI: 10.3899/jrheum.200790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To conduct a needs assessment and environmental scan to support optimal transition from pediatric to adult rheumatology care in Canada. METHODS This initiative involved 3 phases: (1) a survey-based needs assessment of adult and pediatric rheumatologist members of the Canadian Rheumatology Association to identify perceived infrastructure, educational needs, and national resources to support transition care; (2) an environmental scan, through semistructured interviews, of existing rheumatology transition service care models and challenges in care delivery; and (3) a focus group to prioritize national activities. RESULTS The needs assessment survey was completed by 65 members, with 66% agreeing that a national approach to transition care was needed. Semistructured interviews reflecting activities at 9 transition care sites were conducted, and they identified candidate models of care, including direct transfer, progressive transfer, and shared care models. Challenges and needs experienced in these care models reflected resource and infrastructure needs, poor availability of mechanisms to support parents and youth through the transition process, and the need for evaluation to support quality improvement. The focus group and prioritization activity was attended by 26 participants, with each having the ability to cast 3 votes. "Supporting patient education for transition to adult rheumatology health care system" (n = 17 votes) and "advocacy activities to access allied health support, including funding" (n = 10 votes) emerged as the top priorities for national initiatives. CONCLUSION We have identified priorities in education and advocacy for advancing transition care in Canada that require participation of pediatric and adult rheumatology providers, patients, and arthritis stakeholders in the interest of advancing transition care outcomes.
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Affiliation(s)
- Cheryl Barnabe
- C. Barnabe, MD, MSc, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Past-Chair, Quality Care Committee, Canadian Rheumatology Association;
| | - Kelsey Chomistek
- K. Chomistek, BSc, Masters of Science student, Faculty of Graduate Studies, University of Calgary, Calgary, Alberta
| | - Nadia Luca
- N. Luca, MD, MSc, Clinical Assistant Professor in the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Executive, Pediatrics Committee, Canadian Rheumatology Association
| | - Glen Hazlewood
- G. Hazlewood, MD, PhD, Assistant Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Member, Quality Care Committee, Canadian Rheumatology Association
| | - Claire E H Barber
- C.E. Barber, MD, PhD, Assistant Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Member, Quality Care Committee, Canadian Rheumatology Association
| | - Amanda Steiman
- A. Steiman, MD, MSc, Assistant Professor, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, and Chair, Quality Care Committee, Canadian Rheumatology Association
| | - Elizabeth Stringer
- E. Stringer, MD, Associate Professor, Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, and Member, Pediatrics Committee, Canadian Rheumatology Association, Canada
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Michaud K, Wolfe F, Barber CEH. Reply. Arthritis Care Res (Hoboken) 2020; 72:1509-1510. [DOI: 10.1002/acr.24383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Kaleb Michaud
- University of Nebraska Medical Center, Omaha and FORWARD, The National Databank for Rheumatic Diseases, Wichita KS
| | - Frederick Wolfe
- FORWARD The National Databank for Rheumatic Diseases Wichita KS
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Barber CEH, Lacaille D, Faris P, Mosher D, Katz S, Patel JN, Zhang S, Yee K, Barnabe C, Hazlewood GS, Bykerk V, Shiff NJ, Twilt M, Burt J, Benseler SM, Homik J, Marshall DA. Evaluating Quality of Care for Rheumatoid Arthritis for the Population of Alberta Using System-level Performance Measures. J Rheumatol 2020; 48:482-485. [PMID: 32934120 DOI: 10.3899/jrheum.200420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We evaluated 4 national rheumatoid arthritis (RA) system-level performance measures (PM) in Alberta, Canada. METHODS Incident and prevalent RA cases ≥ 16 years of age since 2002 were identified using a validated case definition applied in provincial administrative data. Performance was ascertained through analysis of health data between fiscal years 2012/13-2015/16. Measures evaluated were as follows: proportion of incident RA cases with a rheumatologist visit within 1 year of first RA diagnosis code (PM1); proportion of prevalent RA patients who were dispensed a disease-modifying antirheumatic drug (DMARD) annually (PM2); time from first visit with an RA code to DMARD dispensation and proportion of incident cases where the 14-day benchmark for dispensation was met (PM3); and proportion of patients seen in annual follow-up (PM4). RESULTS There were 31,566 prevalent and 2730 incident RA cases (2012/13). Over the analysis period, the proportion of patients seen by a rheumatologist within 1 year of onset (PM1) increased from 55% to 63%; however, the proportion of RA patients dispensed DMARD annually (PM2) remained low at 43%. While the median time to DMARD from first visit date in people who received DMARD improved over time from 39 days to 28 days, only 38-41% of patients received treatment within the 14-day benchmark (PM3). The percentage of patients seen in yearly follow-up (PM4) varied between 73-80%. CONCLUSION The existing Alberta healthcare system for RA is suboptimal, indicating barriers to accessing specialty care and treatment. Our results inform quality improvement initiatives required within the province to meet national standards of care.
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Affiliation(s)
- Claire E H Barber
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, D.A. Marshall, PhD, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, and Department of Community Health Sciences, University of Calgary, and Arthritis Research Canada, and McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada;
| | - Diane Lacaille
- D. Lacaille, MD, FRCPC, MHSc, Professor, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, and Scientific Director, Arthritis Research Canada
| | - Peter Faris
- P. Faris, PhD, Director, Health Services Statistical and Analytic Methods Analytics (DIMER), S. Zhang, MSc, Senior Data Analyst, K. Yee, MSc, MPH, Senior Data Analyst, Alberta Health Services, Calgary, Alberta, Canada
| | - Dianne Mosher
- D. Mosher, MD, FRCPC, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, and McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada
| | - Steven Katz
- S. Katz, MD, FRCPC, J. Homik, MD, FRCPC, MSc, Professor, Department of Medicine, University of Alberta, Calgary, Alberta, Canada
| | - Jatin N Patel
- J.N. Patel, MBT, Project Manager, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sharon Zhang
- P. Faris, PhD, Director, Health Services Statistical and Analytic Methods Analytics (DIMER), S. Zhang, MSc, Senior Data Analyst, K. Yee, MSc, MPH, Senior Data Analyst, Alberta Health Services, Calgary, Alberta, Canada
| | - Karen Yee
- P. Faris, PhD, Director, Health Services Statistical and Analytic Methods Analytics (DIMER), S. Zhang, MSc, Senior Data Analyst, K. Yee, MSc, MPH, Senior Data Analyst, Alberta Health Services, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, D.A. Marshall, PhD, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, and Department of Community Health Sciences, University of Calgary, and Arthritis Research Canada, and McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada
| | - Glen S Hazlewood
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, D.A. Marshall, PhD, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, and Department of Community Health Sciences, University of Calgary, and Arthritis Research Canada, and McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada
| | - Vivian Bykerk
- V. Bykerk, MD, FRCPC, Associate Professor, Hospital for Special Services, New York, New York, USA
| | - Natalie J Shiff
- N. J. Shiff, MD, MHSc, Adjunct Professor, Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marinka Twilt
- M. Twilt, MD, MSCE, PhD, Assistant Professor, S.M. Benseler, MD, PhD, Professor, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Burt
- J. Burt, PT, ACPAC-trained ERP, St Clare's Mercy Hospital, St. John's, Newfoundland, Canada
| | - Susanne M Benseler
- M. Twilt, MD, MSCE, PhD, Assistant Professor, S.M. Benseler, MD, PhD, Professor, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joanne Homik
- S. Katz, MD, FRCPC, J. Homik, MD, FRCPC, MSc, Professor, Department of Medicine, University of Alberta, Calgary, Alberta, Canada
| | - Deborah A Marshall
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, D.A. Marshall, PhD, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, and Department of Community Health Sciences, University of Calgary, and Arthritis Research Canada, and McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada
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Barber CEH, Then KL, Bohm V, Hall M, Marshall DA, Rankin JA, Barnabe C, Hazlewood GS, Li LC, Mosher D, Homik J, MacMullan P, Tsui K, English K, Lacaille D. Development of a Patient-centered Quality Measurement Framework for Measuring, Monitoring, and Optimizing Rheumatoid Arthritis Care in Canada. J Rheumatol 2020; 48:326-334. [PMID: 33452175 DOI: 10.3899/jrheum.200688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to develop a patient-centered quality measurement framework to address a predefined vision statement and 7 strategic objectives for rheumatoid arthritis (RA) care that was developed in prior qualitative work with arthritis stakeholders. METHODS One hundred forty-seven RA-related performance measures (PMs) were identified from a systematic review. A candidate list of 26 PMs meeting predefined criteria and addressing the strategic objectives previously defined was then assessed during a 3-round (R) modified Delphi. Seventeen panelists with expertise in RA, quality measurement, and/or lived experience with RA rated each PM on a 1-9 scale based on the items of importance, feasibility, and priority for inclusion in the framework during R1 and R3, with a moderated discussion in R2. PMs with median scores ≥ 7 on all 3 items without disagreement were included in the final set, which then underwent public comment. RESULTS Twenty-one measures were included in the final framework (15 PMs from the Delphi and 6 published system-level measures on access to care and treatment). The measures included 4 addressing early access to care and timely diagnosis, 12 evidence-based care for RA and related comorbidities, 1 addressing patient participation as an informed partner in care, and 4 on patient outcomes. CONCLUSION The proposed framework builds upon existing measures capturing early access to care and treatment in RA and adds important PMs to promote high-quality RA care and outcome measurement. In the next phase, the authors will test the framework in clinical practice in addition to addressing certain areas where no suitable PMs were identified.
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Affiliation(s)
- Claire E H Barber
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, D.A. Marshall, PhD, Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, Department of Medicine, Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada;
| | - Karen L Then
- K.L. Then, ACNP, CCN(C), PhD, Professor, M. Hall, MSc, CCRP, Research Associate, J.A. Rankin, ACNP, PhD, Professor, Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Victoria Bohm
- V. Bohm, MSc, MPH, Research Associate, D. Mosher, MD, FRCPC, Professor, P. MacMullan, MBBCh, BAO, MRCPI, MD, Clinical Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Marc Hall
- K.L. Then, ACNP, CCN(C), PhD, Professor, M. Hall, MSc, CCRP, Research Associate, J.A. Rankin, ACNP, PhD, Professor, Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Deborah A Marshall
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, D.A. Marshall, PhD, Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, Department of Medicine, Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada
| | - James A Rankin
- K.L. Then, ACNP, CCN(C), PhD, Professor, M. Hall, MSc, CCRP, Research Associate, J.A. Rankin, ACNP, PhD, Professor, Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Cheryl Barnabe
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, D.A. Marshall, PhD, Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, Department of Medicine, Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada
| | - Glen S Hazlewood
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, D.A. Marshall, PhD, Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, Department of Medicine, Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada
| | - Linda C Li
- L.C. Li, PT, PhD, Professor, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, and Arthritis Research Canada
| | - Dianne Mosher
- V. Bohm, MSc, MPH, Research Associate, D. Mosher, MD, FRCPC, Professor, P. MacMullan, MBBCh, BAO, MRCPI, MD, Clinical Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Joanne Homik
- J. Homik, MD, FRCPC, MSc, Professor, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Paul MacMullan
- V. Bohm, MSc, MPH, Research Associate, D. Mosher, MD, FRCPC, Professor, P. MacMullan, MBBCh, BAO, MRCPI, MD, Clinical Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Karen Tsui
- K. Tsui, MScPT, ACPAC, Arthritis Patient Advisory Board (APAB) member, K. English, Arthritis Patient Advisory Board (APAB) member, Arthritis Patient Advisory Board
| | - Kelly English
- K. Tsui, MScPT, ACPAC, Arthritis Patient Advisory Board (APAB) member, K. English, Arthritis Patient Advisory Board (APAB) member, Arthritis Patient Advisory Board
| | - Diane Lacaille
- D. Lacaille, MD, FRCPC, MHSc, Professor, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, and Scientific Director, Arthritis Research Canada
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Carr ECJ, Ortiz MM, Patel JN, Barber CEH, Katz S, Robert J, Mosher D, Teare SR, Miller J, Homik J, Dinsmore K, Marshall DA. Models of Arthritis Care: A Systems-level Evaluation of Acceptability as a Dimension of Quality of Care. J Rheumatol 2020; 47:1431-1439. [PMID: 31732557 DOI: 10.3899/jrheum.190501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe a systems-level baseline evaluation of central intake (CI) and triage systems in arthritis care within Alberta, Canada. The specific objectives were to (1) describe a process for systems evaluation for the provision of arthritis care; (2) report the findings of the evaluation for different clinical sites that provide arthritis care; and (3) identify opportunities for improving appropriate and timely access based on the findings of the evaluation. METHODS The study used a convergent mixed methods design. Surveys and semistructured interviews were the main data collection methods. Participants were recruited through 2 rheumatology clinics and 1 hip and knee clinic providing CI and triage, and included patients, referring physicians, specialists, and clinic staff who experienced CI processes. RESULTS A total of 237 surveys were completed by patients (n = 169), referring physicians (n = 50), and specialists (n = 18). Interviews (n = 25) with care providers and patients provided insights to the survey data. Over 95% of referring physicians agreed that the current process of CI was satisfactory. Referring physicians and specialists reported issues with the referral process and perceived support in care for wait-listed patients. Patients reported positive experiences with access and navigation of arthritis care services but expressed concerns around communication and receiving minimal support for self-management of their arthritis before and after receiving specialist care. CONCLUSION This baseline evaluation of CI and triage for arthritis care indicates satisfaction with the service, but areas that require further consideration are referral completion, timely waiting lists, and further supporting patients to self-manage their arthritis.
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Affiliation(s)
- Eloise C J Carr
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada. .,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary.
| | - Mia M Ortiz
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Jatin N Patel
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Claire E H Barber
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Steven Katz
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Jill Robert
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Dianne Mosher
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Sylvia R Teare
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Jean Miller
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Joanne Homik
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Kelly Dinsmore
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Deborah A Marshall
- From the Faculty of Nursing, University of Calgary; Strategic Clinical Networks, Alberta Health Services; Division of Rheumatology, and Community Health Sciences, Cumming School of Medicine, University of Calgary; Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary; Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton; Chinook Bone and Joint Clinic, Lethbridge, Alberta, Canada.,E.C. Carr, RN, PhD, Professor, Faculty of Nursing, University of Calgary; M.M. Ortiz, RN, BN, Faculty of Nursing, Professional Faculties Building, University of Calgary; J.N. Patel, MBT, Pan-SCN Manager, Strategic Clinical Networks, Alberta Health Services; C.E. Barber, MD, FRCPC, PhD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S. Katz, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Alberta; J. Robert, BScN, Surgery, and Bone and Joint Health Strategic Clinical Networks, Alberta Health Services; D. Mosher, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; S.R. Teare, BScN Med, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Miller, PhD, Community Health Sciences, Cumming School of Medicine, University of Calgary; J. Homik, MD, MSc, Professor, Department of Medicine, Division of Rheumatology, University of Alberta; K. Dinsmore, MSc, Chinook Bone and Joint Clinic; D.A. Marshall, MHSA, PhD, Professor, Community Health Sciences, Cumming School of Medicine, University of Calgary
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England BR, Barber CEH, Bergman M, Ranganath VK, Suter LG, Michaud K. Brief Report: Adaptation of American College of Rheumatology Rheumatoid Arthritis Disease Activity and Functional Status Measures for Telehealth Visits. Arthritis Care Res (Hoboken) 2020; 73:1809-1814. [PMID: 32813284 PMCID: PMC7461171 DOI: 10.1002/acr.24429] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/13/2020] [Indexed: 12/03/2022]
Abstract
Objective To provide guidance on the implementation of recommended American College of Rheumatology (ACR) rheumatoid arthritis (RA) disease activity and functional status assessment measures in telehealth settings. Methods An expert panel was assembled from the recently convened ACR RA disease activity and functional status measures working groups to summarize strategies for implementation of ACR‐recommended RA disease activity (the Clinical Disease Activity Index [CDAI], Disease Activity Score in 28 joints using the erythrocyte sedimentation rate or the C‐reactive protein level [DAS28‐ESR/CRP], Patient Activity Scale II [PAS‐II], Simplified Disease Activity Index [SDAI], and Routine Assessment of Patient Index Data 3 [RAPID3]) and functional status (the Health Assessment Questionnaire II [HAQ‐II], Multidimensional Health Assessment Questionnaire [MDHAQ], and PROMIS physical function 10‐item short form [PROMIS PF‐10]) measures in telehealth settings. Results Measures composed of patient‐reported items (disease activity: PAS‐II, RAPID3; functional status: HAQ‐II, MDHAQ, PROMIS PF‐10) require minimal modification for use in telehealth settings. Measures requiring formal joint counts (the CDAI, DAS28‐ESR/CRP, and SDAI) can be calculated using patient‐reported swollen and tender joint counts. When the feasibility of laboratory testing is limited, the CDAI can be used in place of the SDAI, and scoring modifications of the DAS28‐ESR/CRP without the acute‐phase reactant are available. Assessment of the validity of these modifications is limited. Implementation of these measures can be facilitated by electronic health record collection, mobile applications, and provider/staff administration during telehealth visits. Conclusion The ACR‐recommended RA disease activity and functional status measures can be adapted for use in telehealth settings to support high‐quality clinical care. Research is needed to better understand how telehealth settings may impact the validity of these measures.
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Affiliation(s)
- Bryant R England
- Division of Rheumatology & Immunology, University of Nebraska Medical Center & VA Nebraska-Western Iowa Heath Care System, Omaha, NE, United States
| | - Claire E H Barber
- Department of Medicine & Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Arthritis Research Canada, Canada
| | - Martin Bergman
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Veena K Ranganath
- University of California, David Geffen School of Medicine, Los Angeles, California, USA
| | - Lisa G Suter
- Yale University School of Medicine, Department of Medicine, Section of Rheumatology, Yale-New Haven Health System, Center for Outcome Research and Evaluation, Veterans Affairs Connecticut Health System, United States
| | - Kaleb Michaud
- Division of Rheumatology & Immunology, University of Nebraska Medical Center & VA Nebraska-Western Iowa Heath Care System, Omaha, NE, United States.,FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, United States
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Marshall DA, Pham T, Faris P, Chen G, O’Donnell S, Barber CEH, LeClercq S, Katz S, Homik J, Patel JN, Lopatina E, Roberts J, Mosher D. Determination of Rheumatoid Arthritis Incidence and Prevalence in Alberta Using Administrative Health Data. ACR Open Rheumatol 2020; 2:424-429. [PMID: 32567816 PMCID: PMC7368140 DOI: 10.1002/acr2.11158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The objective of the study was to estimate the incidence and prevalence of rheumatoid arthritis (RA) in Alberta using administrative health data. METHODS We identified RA cases in patients 16 years and older by applying a national case definition to linked administrative health data (ie, hospital discharge abstract records, physician claims, and health insurance registry records) using a unique personal identifier. Incidence and prevalence are reported for the 2015-2016 fiscal year and a trend analysis from 2011-2012 to 2015-2016. Incidence and prevalence estimates were standardized using the 2011 Canadian census population. RESULTS In 2015-2016, the overall crude incidence was 0.74 [95% confidence interval (CI): 0.71-0.77] per 1000 and crude prevalence was 1.08% (95% CI: 1.07-1.09). The women-to-men crude incidence and prevalence sex ratios were 2.04 and 2.19, respectively. People aged 65 to 79 years had the highest incidence of RA, and the highest prevalence was observed among those 80 years and older. From 2011-2012 to 2015-2016, the overall age-standardized incidence decreased [0.97 (95% CI: 0.94-1.01) to 0.79 (95% CI: 0.76-0.82) per 1000], whereas age-standardized prevalence remained constant [1.17 (95% CI: 1.15-1.18) to 1.18 (95% CI: 1.17-1.19)]. CONCLUSION In Alberta, there was a decreasing trend in RA incidence over the study period, whereas prevalence was stable. These estimates, combined with clinical data, will be used to measure system performance for quality improvement and to inform simulation modeling for planning the expected demand for health services for patients living with RA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jatin N. Patel
- University of Calgary, Calgary, Alberta and Alberta Health ServicesCalgaryAlbertaCanada
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Kulhawy-Wibe SC, Zell J, Michaud K, Yazdany J, Davis AM, Ehrlich-Jones L, Thorne JC, Everix D, Cappelli LC, Suter LG, Limanni A, Barber CEH. Systematic Review and Appraisal of the Cross-Cultural Validity of Functional Status Assessment Measures in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2020; 72:798-805. [PMID: 30980507 PMCID: PMC7317906 DOI: 10.1002/acr.23904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/09/2019] [Indexed: 11/26/2022]
Abstract
Objective We conducted a systematic review and appraisal of the cross‐cultural adaptation and cross‐cultural validity of the Health Assessment Questionnaire (HAQ) and its derivatives, and of the more recent Patient‐Reported Outcomes Measurement Information System (PROMIS) functional status assessment measures (FSAMs) in rheumatoid arthritis. Methods Four electronic medical databases were searched from inception until April 4, 2018 according to the Consensus‐Based Standards for the Selection of Health Measurement Instruments (COSMIN) group search strategy. Included studies were evaluated using the COSMIN tool for cross‐cultural validity and were scored as excellent, good, fair, or poor. Results Of 58 articles identified by our search strategy and 3 by manual search, 39 were included: 29 described the translation, cultural adaptation, or cross‐cultural validity of the HAQ disability index, 8 other HAQ derivatives, and 2 PROMIS measures, representing 22 languages. Of the 39 articles reviewed, 3 examined the cross‐cultural validity of translated versions. These studies were rated as follows: 2 as excellent, 3 good, 13 fair, and 21 poor. Two studies examining cross‐cultural validity noted differential item functioning (DIF) between Dutch and US populations for the HAQ‐II and PROMIS measures, and a third study found DIF between Turkish and UK populations on the HAQ, indicating cultural differences in questionnaire response. Conclusion This review highlights a paucity of data on the cross‐cultural validity of FSAMs and the mostly poor‐ or fair‐quality methods by which they were translated and adapted, which needs to be considered when using these measures for multinational clinical trials and for day‐to‐day use in clinical practice.
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Affiliation(s)
| | - JoAnn Zell
- Denver Health and University of Colorado, Denver
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | | | - Aileen M Davis
- Krembil Research Institute, University Health Network, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Claire E H Barber
- Cumming School of Medicine, University of Calgary, and Arthritis Research Canada, Calgary, Alberta, Canada
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Barber CEH, Twilt M, Pham T, Currie GR, Benseler S, Yeung RSM, Batthish M, Blanchette N, Guzman J, Lang B, LeBlanc C, Levy DM, O'Brien C, Schmeling H, Soon G, Spiegel L, Whitney K, Marshall DA. A Canadian evaluation framework for quality improvement in childhood arthritis: key performance indicators of the process of care. Arthritis Res Ther 2020; 22:53. [PMID: 32192528 PMCID: PMC7083048 DOI: 10.1186/s13075-020-02151-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/09/2020] [Indexed: 01/22/2023] Open
Abstract
Background The evaluation of quality of care in juvenile idiopathic arthritis (JIA) is critical for advancing patient outcomes but is not currently part of routine care across all centers in Canada. The study objective is to review the current landscape of JIA quality measures and use expert panel consensus to define key performance indicators (KPIs) that are important and feasible to collect for routine monitoring in JIA care in Canada. Methods Thirty-seven candidate KPIs identified from a systematic review were reviewed for inclusion by a working group including 3 pediatric rheumatologists. A shortlist of 14 KPIs was then assessed using a 3-round modified Delphi panel based on the RAND/UCLA Appropriateness Method. Ten panelists across Canada participated based on their expertise in JIA, quality measurement, or lived experience as a parent of a child with JIA. During rounds 1 and 3, panelists rated each KPI on a 1–9 Likert scale on themes of importance, feasibility, and priority. In round 2, panelists participated in a moderated in-person discussion that resulted in minor modifications to some KPIs. KPIs with median scores of ≥ 7 on all 3 questions without disagreement were included in the framework. Results Ten KPIs met the criteria for inclusion after round 3. Five KPIs addressed patient assessments: pain, joint count, functional status, global assessment of disease activity, and the clinical Juvenile Arthritis Disease Activity Score (cJADAS). Three KPIs examined access to care: wait times for consultation, access to pediatric rheumatologists within 1 year of diagnosis, and frequency of clinical follow-up. Safety was addressed through KPIs on tuberculous screening and laboratory monitoring. KPIs examining functional status using the Childhood Health Assessment Questionnaire (CHAQ), quality of life, uveitis, and patient satisfaction were excluded due to concerns about feasibility of measurement. Conclusions The proposed KPIs build upon existing KPIs and address important processes of care that should be measured to improve the quality of JIA care. The feasibility of capturing these measures will be tested in various data sources including the Understanding Childhood Arthritis Network (UCAN) studies. Subsequent work should focus on development of meaningful outcome KPIs to drive JIA quality improvement in Canada and beyond.
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Affiliation(s)
- Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marinka Twilt
- Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Tram Pham
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gillian R Currie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Susanne Benseler
- Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Rae S M Yeung
- Departments of Pediatrics, Immunology and Medical Science, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle Batthish
- Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada
| | - Nicholas Blanchette
- The Hospital for Sick Children, Toronto, ON, Canada.,Trillium Health Partners, Mississauga, ON, Canada
| | - Jaime Guzman
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bianca Lang
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Claire LeBlanc
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Deborah M Levy
- Departments of Pediatrics, Immunology and Medical Science, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Heinrike Schmeling
- Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Gordon Soon
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Lynn Spiegel
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Deborah A Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Hazlewood GS, Marshall DA, Barber CEH, Li LC, Barnabe C, Bykerk V, Tugwell P, Hull PM, Bansback N. Using a Discrete-Choice Experiment in a Decision Aid to Nudge Patients Towards Value-Concordant Treatment Choices in Rheumatoid Arthritis: A Proof-of-Concept Study. Patient Prefer Adherence 2020; 14:829-838. [PMID: 32546977 PMCID: PMC7244245 DOI: 10.2147/ppa.s221897] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 02/27/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate, in a proof-of-concept study, a decision aid that incorporates hypothetical choices in the form of a discrete-choice experiment (DCE), to help patients with early rheumatoid arthritis (RA) understand their values and nudge them towards a value-centric decision between methotrexate and triple therapy (a combination of methotrexate, sulphasalazine and hydroxychloroquine). PATIENTS AND METHODS In the decision aid, patients completed a series of 6 DCE choice tasks. Based on the patient's pattern of responses, we calculated his/her probability of choosing each treatment, using data from a prior DCE. Following pilot testing, we conducted a cross-sectional study to determine the agreement between the predicted and final stated preference, as a measure of value concordance. Secondary outcomes including time to completion and usability were also evaluated. RESULTS Pilot testing was completed with 10 patients and adjustments were made. We then recruited 29 patients to complete the survey: median age 57, 55% female. The patients were all taking treatment and had well-controlled disease. The predicted treatment agreed with the final treatment chosen by the patient 21/29 times (72%), similar to the expected agreement from the mean of the predicted probabilities (68%). Triple therapy was the predicted treatment 24/29 times (83%) and chosen 20/29 (69%) times. Half of the patients (51%) agreed that completing the choice questions helped them to understand their preferences (38% neutral, 10% disagreed). The tool took an average of 15 minutes to complete, and median usability scores were 55 (system usability scale) indicating "OK" usability. CONCLUSION Using a DCE as a value-clarification task within a decision aid is feasible, with promising potential to help nudge patients towards a value-centric decision. Usability testing suggests further modifications are needed prior to implementation, perhaps by having the DCE exercises as an "add-on" to a simpler decision aid.
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Affiliation(s)
- Glen S Hazlewood
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- McCaig Institute of Bone and Joint Health, University of Calgary, Calgary, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
- Correspondence: Glen S Hazlewood Departments of Medicine and Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, 3AA10, CalgaryAB T2N 4Z6, CanadaTel +1 403 220-5903Fax +1 403 210-3899 Email
| | - Deborah A Marshall
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- McCaig Institute of Bone and Joint Health, University of Calgary, Calgary, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Claire E H Barber
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- McCaig Institute of Bone and Joint Health, University of Calgary, Calgary, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Linda C Li
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- McCaig Institute of Bone and Joint Health, University of Calgary, Calgary, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Vivian Bykerk
- Weill Cornell Medical College, Cornell University, New York, NY, USA
- Department of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - Peter Tugwell
- Department of Medicine, Department of Epidemiology and Community Medicine, Canada Research Chair, University of Ottawa, Institute of Population Health, Ottawa, Canada
| | | | - Nick Bansback
- Arthritis Research Canada, Vancouver, BC, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Barber CEH, Zell J, Yazdany J, Davis AM, Cappelli L, Ehrlich-Jones L, Everix D, Thorne JC, Bohm V, Suter L, Limanni A, Michaud K. 2019 American College of Rheumatology Recommended Patient-Reported Functional Status Assessment Measures in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2019; 71:1531-1539. [PMID: 31709771 DOI: 10.1002/acr.24040] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/08/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop American College of Rheumatology (ACR) recommendations for patient-reported Functional Status Assessment Measures (FSAMs) for use in routine clinical practice in patients with rheumatoid arthritis (RA). METHODS We convened a workgroup to conduct a systematic review of published literature through March 16, 2017 and abstract FSAM properties. Based upon initial search results and clinical input, we focused on the following FSAMs appropriate for routine clinical use: the Health Assessment Questionnaire (HAQ) and derived measures and the Patient-Reported Outcomes Measurement Information System (PROMIS) tool. We used the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 4-point scoring method to evaluate each FSAM, allowing for overall level of evidence assessment. We identified FSAMs fulfilling a predefined minimum standard and, through a modified Delphi process, selected preferred FSAMs for regular use in most clinic settings. RESULTS The search identified 11,835 articles, of which 56 were included in the review. Descriptions of the measures, properties, study quality, level of evidence, and feasibility were abstracted and scored. Following a modified Delphi process, 7 measures fulfilled the minimum standard for regular use in most clinic settings, and 3 measures were recommended: the PROMIS physical function 10-item short form (PROMIS PF10a), the HAQ-II, and the Multidimensional HAQ. CONCLUSION This work establishes ACR recommendations for preferred RA FSAMs for regular use in most clinic settings. These results will inform clinical practice and can support future ACR quality measure development as well as highlight ongoing research needs.
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Affiliation(s)
| | | | | | - Aileen M Davis
- Krembil Research Institute, University Health Network, and University of Toronto, Toronto, Ontario, Canada
| | | | | | - Donna Everix
- Mills Peninsula Health Services, Burlingame, California, and OnMyCare Home Health, Fremont, California
| | | | | | - Lisa Suter
- Yale University, New Haven, Connecticut, and Veterans Affairs Medical Center, West Haven, Connecticut
| | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD, the National Databank for Rheumatic Diseases, Wichita, Kansas
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