SAT0561 DIAGNOSTIC ACCURACY OF GOUT IN ELECTRONIC HEALTH RECORDS AND THE ROLE OF RHEUMATOLOGY ELECTRONIC CONSULTS
Authors: Juliana Chang, Jonathan Tsui, Maida Wong
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Gout is the most prevalent inflammatory arthritis globally. Despite treatment advances, it still has a significant effect on quality of life and healthcare costs. There have been inconsistent studies on administrative coding as an accurate marker of true diagnosis. Although gout can be solely managed by primary care physicians (PCPs), complex cases often require rheumatology consultation. The wait time for an initial rheumatology clinic visit ranges from 38 days to 47 weeks. However, electronic consults (e-consults) allow for swift two-way communication between PCPs and rheumatologists (pre-consult exchange) to facilitate coordination of care among providers. <h3>Objectives:</h3> To determine the accuracy of gout diagnosis based on ICD 9 and 10 coding, and the differences in gout outcomes based on PCP management, e-consult or rheumatology clinic visits at two Veterans Affairs Medical Centers. <h3>Methods:</h3> A retrospective cohort study was created from 2009-2014 including 101 e-consult patients and a control group of 176 patients. In the e-consult group, 78 patients were ICD 9 or 10 coded for gout; in the control group, 116 were ICD 9 or 10 coded for gout. A blinded abstractor determined the accuracy of gout coding based on chart review and EULAR criteria. A second random sample of 183 gout patients from 2009-2014 was identified and stratified to 3 modes of management: PCP only (48), e-consult (68), and rheumatology clinic visit (67). Data was reviewed for 24 months following initial gout diagnosis or e-consult. Management was evaluated based on frequency of flares and related ED visits, creatinine clearance, and serum uric acid levels (sUA). <h3>Results:</h3> The sensitivity and specificity of ICD coding for accurate gout diagnosis was 94% and 79% in the control (PPV 88%, NPV 90%). For e-consult patients, the sensitivity and specificity was 100% and 70% (PPV 87%, NPV 100%). E-consult patients were more accurately diagnosed with gout by PCPs than in the control group (p=0.03). 83% of e-consults were resolved electronically and 17% were converted to rheumatology clinic visits. The mean wait time for e-consult recommendations was 1.8 days. The mean clinic visit wait after pre-consult exchange was 22.9 days compared to an average of 43.1 days for direct rheumatology clinic consults. Both e-consult and rheumatology clinic patients had more gout flares and related ED visits at diagnosis compared to PCP care; however, at 12 months, both groups had significantly fewer gout-related ED visits, decreased sUA, and improved creatinine clearance (p&lt;0.05). <h3>Conclusion:</h3> VA databases are an accurate source of gout patients based on ICD coding. When viewing e-consults, rheumatologists can rely on accurate PCP gout diagnoses, confidently answer clinical questions, and triage more efficiently. E-consult serves as an effective alternative in managing gout with shorter wait times for recommendations and appointments while still reimbursing physicians at a reasonable rate. Therefore, complex gout management can be enhanced by e-consults to improve clinical outcomes, decrease gaps in care and optimize healthcare resources. <h3>References</h3> [1] Zhang W, et al. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65(10):1312-24. [2] Widdifield J, et al. Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data. CMAJ Open. 2016;4(2):E205-12 <h3>Disclosure of Interests:</h3> None declared