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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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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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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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4
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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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5
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Sloss S, Dhiman K, Zafar S, Hartfeld NMS, Lacaille D, Then KL, Li LC, Barnabe C, Hazlewood G, Rankin JA, Hall M, Marshall DA, English K, Tsui K, MacMullan P, Homik J, Mosher D, Barber CE. Development and testing of the Rheumatoid Arthritis Quality of Care Survey. Semin Arthritis Rheum 2022; 54:152002. [DOI: 10.1016/j.semarthrit.2022.152002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
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Pendharkar SR, Minty E, Shukalek CB, Kerr B, MacMullan P, Lail P, Cheema K, Alimohamed N, Allen T, Vlasschaert MEO, Kachra R, Ma IWY, Johannson KA, Gibson PS, Elliott MJ, Papini A, Smith S, Lemaire J, Ruzycki SM, Hunter A, Desjardins-Kallar W, Schaefer JP, Zarnke KB, Bharwani A, Fabreau GE. Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System. J Gen Intern Med 2021; 36:1310-1318. [PMID: 33564947 PMCID: PMC7872510 DOI: 10.1007/s11606-020-06543-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The evolving COVID-19 pandemic has and continues to present a threat to health system capacity. Rapidly expanding an existing acute care physician workforce is critical to pandemic response planning in large urban academic health systems. INTERVENTION The Medical Emergency-Pandemic Operations Command (MEOC)-a multi-specialty team of physicians, operational leaders, and support staff within an academic Department of Medicine in Calgary, Canada-partnered with its provincial health system to rapidly develop a comprehensive, scalable pandemic physician workforce plan for non-ventilated inpatients with COVID-19 across multiple hospitals. The MEOC Pandemic Plan comprised seven components, each with unique structure and processes. METHODS In this manuscript, we describe MEOC's Pandemic Plan that was designed and implemented from March to May 2020 and re-escalated in October 2020. We report on the plan's structure and process, early implementation outcomes, and unforeseen challenges. Data sources included MEOC documents, health system, public health, and physician engagement implementation data. KEY RESULTS From March 5 to October 26, 2020, 427 patients were admitted to COVID-19 units in Calgary hospitals. In the initial implementation period (March-May 2020), MEOC communications reached over 2500 physicians, leading to 1446 physicians volunteering to provide care on COVID-19 units. Of these, 234 physicians signed up for hospital shifts, and 227 physicians received in-person personal protective equipment simulation training. Ninety-three physicians were deployed on COVID-19 units at four large acute care hospitals. The resurgence of cases in September 2020 has prompted re-escalation including re-activation of COVID-19 units. CONCLUSIONS MEOC leveraged an academic health system partnership to rapidly design, implement, and refine a comprehensive, scalable COVID-19 acute care physician workforce plan whose components are readily applicable across jurisdictions or healthcare crises. This description may guide other institutions responding to COVID-19 and future health emergencies.
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Affiliation(s)
- Sachin R Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Evan Minty
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Caley B Shukalek
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brendan Kerr
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Paul MacMullan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Parabhdeep Lail
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Kim Cheema
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Nimira Alimohamed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Thomas Allen
- Cumming School of Medicine, University of Calgary, Health Sciences Centre, Calgary, AB, Canada
| | - Meghan E O Vlasschaert
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Rahim Kachra
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Health Sciences Centre, Calgary, AB, Canada
| | - Irene W Y Ma
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kerri A Johannson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul S Gibson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Meghan J Elliott
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adam Papini
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Stephanie Smith
- Cumming School of Medicine, University of Calgary, Health Sciences Centre, Calgary, AB, Canada
| | - Jane Lemaire
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Shannon M Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Angela Hunter
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Wendy Desjardins-Kallar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Jeffrey P Schaefer
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
| | - Kelly B Zarnke
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Aleem Bharwani
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gabriel E Fabreau
- Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre - North Tower, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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7
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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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Trpkov C, MacMullan P, Feuchter P, Kachra R, Heydari B, Merchant N, Bristow MS, White JA. Rapid Response to Cytokine Storm Inhibition Using Anakinra in a Patient With COVID-19 Myocarditis. CJC Open 2020; 3:210-213. [PMID: 33073222 PMCID: PMC7550126 DOI: 10.1016/j.cjco.2020.10.003] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022] Open
Abstract
A 62-year-old woman with coronavirus disease 2019 developed acute respiratory failure and cardiogenic shock in the setting of a systemic hyperinflammatory state and apparent ST-elevation myocardial infarction. Cardiac magnetic resonance imaging showed fulminant acute myocarditis with severe left ventricular dysfunction. Treatment with the recombinant interleukin-1 receptor antagonist anakinra and dexamethasone resulted in rapid clinical improvement, reduction in serum inflammatory markers, and a marked recovery in cardiac magnetic resonance--based markers of inflammation and contractile dysfunction. The patient was subsequently discharged from the hospital. Emerging evidence supports use of anti-inflammatory therapies, including anakinra and dexamethasone, in severe cases of coronavirus disease 2019.
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Affiliation(s)
- Cvetan Trpkov
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul MacMullan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patricia Feuchter
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Rahim Kachra
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bobak Heydari
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Naeem Merchant
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael S Bristow
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James A White
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, 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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Campbell TN, Frizzell B, MacMullan P. Chronic non-bacterial osteomyelitis masquerading as fibrous dysplasia. Mod Rheumatol Case Rep 2020; 4:192-195. [PMID: 33087020 DOI: 10.1080/24725625.2020.1728062] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/07/2020] [Indexed: 06/11/2023]
Abstract
Chronic non-bacterial osteomyelitis is a rare auto-inflammatory bone disease seen predominantly in the paediatric population. We describe a unique case of a 30-year-old female who presented with right-sided jaw pain and intermittent swelling over the course of 6 years. She was initially treated with antibiotics for possible osteomyelitis, then temporarily diagnosed with fibrous dysplasia. She underwent extensive investigations consisting of an infectious workup, numerous imaging modalities, and three separate biopsies of her right jaw. She was ultimately diagnosed with chronic non-bacterial osteomyelitis based upon her history of recurrent episodes of painful swelling, response to non-steroidal anti-inflammatories, previously raised acute phase reactants, and magnetic resonance imaging findings. Unfortunately, she became refractory to non-steroidal anti-inflammatory therapy. Consequently, she was successfully treated with pamidronate, achieving clinical remission with improvement in her imaging findings. This case highlights the difficulty of diagnosis of chronic non-bacterial osteomyelitis and the need for increased awareness of the disease in the adult population. Additionally, the effective treatment with pamidronate supports the use of a bisphosphonate as an early intervention for adult-onset chronic non-bacterial osteomyelitis in patients who have failed non-steroidal anti-inflammatory therapy.
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Affiliation(s)
- Tessa N Campbell
- Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Bevan Frizzell
- Department of Radiology, University of Calgary, Calgary, Canada
| | - Paul MacMullan
- Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Canada
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Barber CEH, Sandhu N, Rankin JA, MacMullan P, Marshall DA, Barnabe C, Hazlewood GS, Emrick A, Stevenson M, Then KL, Benseler S, Twilt M, Mosher D. Rheum4U: Development and testing of a web-based tool for improving the quality of care for patients with rheumatoid arthritis. Clin Exp Rheumatol 2019; 37:385-392. [PMID: 30183602] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To develop a web-based tool (Rheum4U) to capture clinically meaningful data to direct treatment. Rheum4U integrates longitudinal clinical data capture of rheumatoid arthritis (RA) disease activity measures and patient-reported outcomes measures (PROMs). This study tests the feasibility, acceptability and efficiency of Rheum4U among patients and healthcare providers. METHODS Rheum4U was developed in two phases: P1 design and development; and P2 pilot testing. P1: A working group of rheumatologists and researchers (n=13) performed a prioritisation exercise to determine data elements to be included in the platform. The specifications were finalised and supplied to the platform developer. Alpha testing was performed to correct initial software bugs. 18 testers (physicians, nurses and recruited non-patient lay-testers) beta tested Rheum4U for usability. P2: Rheum4U was piloted in 2 rheumatology clinics and evaluated for feasibility, efficiency and acceptability using interviews, observation and questionnaires with patients and healthcare providers. RESULTS 110 RA patients, 9 rheumatologists and 9 allied health providers participated in the pilot. Mean patient age was 53 years and 74% were female. The majority (86%) were satisfied or very satisfied with online data entry and 79% preferred it to paper entry. Healthcare providers found Rheum4U easy and clear to use (90%), and they perceived that it improved their job performance (91%). Completeness and easy availability of the patient information improved clinic efficiency. CONCLUSIONS Rheum4U highlights the benefits of a web-based tool for clinical care, quality improvement and research in the clinic and this study provides valuable information to inform full platform implementation.
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Affiliation(s)
- Claire E H Barber
- Div.of Rheumatology, Department of Medicine; Department of Community Health Sciences University of Calgary, Cumming School of Medicine, Alberta; Arthritis Research Canada; and McCaig Inst. for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Namneet Sandhu
- Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Alberta, Canada
| | - James A Rankin
- Faculty of Nursing, University of Calgary & Alberta Health Services, Alberta, Canada
| | - Paul MacMullan
- Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences University of Calgary, Cumming School of Medicine, Alberta; Arthritis Research Canada; and McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Div.of Rheumatology, Department of Medicine; Department of Community Health Sciences University of Calgary, Cumming School of Medicine, Alberta; Arthritis Research Canada; and McCaig Inst. for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Glen S Hazlewood
- Div.of Rheumatology, Department of Medicine; Department of Community Health Sciences University of Calgary, Cumming School of Medicine, Alberta; Arthritis Research Canada; and McCaig Inst. for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Andrea Emrick
- Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Alberta, Canada
| | - Martina Stevenson
- Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Alberta, Canada
| | - Karen L Then
- Faculty of Nursing, University of Calgary & Alberta Health Services, Alberta, Canada
| | - Susanne Benseler
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Alberta, Canada
| | - Marinka Twilt
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Alberta, Canada
| | - Dianne Mosher
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
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Thomson S, Urbanski S, MacMullan P. Clinical Images: Gouty Tophus as an Unusual Cause of Talus Fracture. Arthritis Rheumatol 2017; 69:1508. [DOI: 10.1002/art.40103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/16/2017] [Indexed: 11/11/2022]
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Orr C, Young F, MacMullan P, O'Dwyer E, Veale D. AB0337 Improving the Quality and Efficiency of Clinic Visits for IA Patients by Preparing for their Visit. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Murphy CL, Madigan A, MacMullan P, Bell L, Durcan L, Fathelrahim I, Kavanagh P, Geraghty E, Helbert L, Stephens K, Dunne E, Kenny D, McCarthy G. AB0060 Soluble Glycoprotein VI: A Potential Biomarker for Disease Activity and Platelet Reactivity in Gout. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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