SAT0126 Characterizing heterogeneous care pathways of incident rheumatoid arthritis patients
Authors: A.A. Kawatkar, J. An, A. Marshall, T. C. Cheetham, E. Haupt, G. Okano, K. Gupta, T. G. Curtice
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Clinical pathway analysis is the process of characterizing clinical activities in patients' (pts) care. Little is known about the clinical pathways that pts with rheumatoid arthritis (RA) follow after their diagnosis, and how treatment patterns differ between such pathways. <h3>Objectives</h3> To identify and characterize distinct clinical pathways in the management of incident RA pts and evaluate differences in treatment patterns. <h3>Methods</h3> A retrospective cohort study was conducted in RA pts identified using electronic medical records of the Kaiser Permanente Southern California health plan. Between 01/01/2007 and 31/12/2015, we identified adult pts (aged ≥18 years) who had at least two RA diagnoses within a 12-month period, a disease-modifying antirheumatic drug (DMARD) prescription and laboratory test for anti-citrullinated peptide antibody. Latent class analysis (LCA) method was applied to identify ≥2 heterogeneous care pathways. RA-specific healthcare utilization during the first year following the RA diagnosis was used as a marker of underlying latent classes. We characterized the latent classes based on the distribution of markers, co-morbidities and RA treatment patterns including switch, augmentation and discontinuation of DMARDs. Chi-square and F-tests were used to evaluate differences between the classes. <h3>Results</h3> We identified 2843 incident RA pts. LCA indicated five latent classes representing mutually exclusive pathways of managing pts with RA. Pts in Class 1 (low disease activity-low progression) had lowest RA office visits and labs to detectinflammation with the highest DMARD discontinuation. Pts in Class 2 (lowdisease activity-moderate progression) were characterized by higher lab, imaging and DMARD augmentation. Class 3 (moderate disease activity with pain) was characterized by highest use of NSAIDs across any class. Pts in Class 4(high disease activity-moderate progression) were characterized by above-average RA office visits and the highest corticosteroid use. Class 5(high disease activity-high progression) had pts with the highest number of RAoffice visits, biologic DMARD use, DMARD augmentation, DMARD switching and the lowest initial treatment discontinuation. <h3>Conclusions</h3> We identified five distinct classes/care pathways; these could be used to identify care gaps, implement standardized care plans and guide quality initiatives in the management of pts with RA. <h3>Disclosure of Interest:</h3> A. KawatkarGrant/research support from: Bristol-Myers Squibb, J. An Grant/research support from: Bristol-Myers Squibb/Pfizer, A. Marshall Shareholder of: Bristol-MyersSquibb, Employee of: Bristol-Myers Squibb, T. C. Cheetham Grant/researchsupport from: Bristol-Myers Squibb, E. Haupt Grant/research support from: Bristol-Myers Squibb, G. Okano Employee of: Bristol-Myers Squibb, K. GuptaEmployee of: Bristol-Myers Squibb, T. Curtice Shareholder of: Bristol-MyersSquibb, Employee of: Bristol-Myers Squibb