Electronic and Lab Pre-screening of New Rheumatology Patients With Rheumatoid Arthritis

Study Overview
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Brief Summary
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By forming the foundation of a delivery system that integrates primary care (PC) and rheumatology, this initiative strives to strengthen the roles of both primary care and rheumatology practices as they co-manage patients in a quality care delivery system. Importantly, it strives to fill an unmet need, the rapid evaluation by Primary Care providers; the appropriate and timely referral of inflammatory disease patients to a rheumatologist; and the implementation of early aggressive therapy in the management of patients with rheumatoid arthritis (RA) with tight control. Given the call for improved quality, value, and demonstration of results[1], this initiative uses the tenets of National Center for Quality Assurance's Patient Centered Specialty Program[1] (PCSP) and it successfully masters and streamlines coordination of care.

Official Title
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Electronic and Lab Pre-screening of New Rheumatology Patients

Conditions
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Rheumatoid Arthritis, Inflammatory Arthritis

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: First ever referral to a rheumatologist. Exclusion Criteria: -

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Non-E-referral<br>Patients who are referred in the traditional manner between two separate organizations. | |
| E-referral<br>Patients who are referred in an automated manner between two separate organizations. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To increase referral efficiencies through an electronic system to decrease the timeline prior | Mean and median time (in days) to the first rheumatology visit from PCP referral for both cohorts | One year enrollment period | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To assess difference in disease activity progression using Clinical Disease Activity Index (CDAI) at both 12 and 24 months. | The change in CDAI score from baseline at 1 and 2 years. CDAI uses a scale of 0 - 60 where scores less than 2.8 are considered remission, 2.9 - 10.0 are low disease activity, 10.1 - 22.0 are moderate disease activity, and 22.1 or higher are high disease activity. | One year enrollment period with two year follow-up period. | 
| To assess difference in disease activity progression using Routine Assessment of Patient Index Data (RAPID3) at both 12 and 24 months. | The change in RAPID3 score from baseline at 1 and 2 years. RAPID3 uses a scale of 0 - 30 where scores less than 3.1 are considered remission, 3.1 - 6.0 are low disease activity, 6.1 - 12.0 are moderate disease activity, and 12.1 or higher are high disease activity. | One year enrollment period with two year follow-up period. | 
| To assess radiographic progression using sharp scores in the electronically referred cohorts versus the traditional cohort. | The change in sharp scores from baseline at 1 and 2 years. | One year enrollment period with two year follow-up period. |