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Ahluwalia V, Lineker S, Sweezie R, Bell MJ, Kendzerska T, Widdifield J, Bombardier C. The Effect of Triage Assessments on Identifying Inflammatory Arthritis and Reducing Rheumatology Wait Times in Ontario. J Rheumatol 2019; 47:461-467. [PMID: 31154411 DOI: 10.3899/jrheum.180734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We evaluated the influence of triage assessments by extended role practitioners (ERP) on improving timeliness of rheumatology consultations for patients with suspected inflammatory arthritis (IA) or systemic autoimmune rheumatic diseases (SARD). METHODS Rheumatologists reviewed primary care providers' referrals and identified patients with inadequate referral information, so that a decision about priority could not be made. Patients were assessed by an ERP to identify those with IA/SARD requiring an expedited rheumatologist consult. The time from referral to the first consultation was determined comparing patients who were expedited to those who were not, and to similar patients in a usual care control group identified through retrospective chart review. RESULTS Seven rheumatologists from 5 communities participated in the study. Among 177 patients who received an ERP triage assessment, 75 patients were expedited and 102 were not. Expedited patients had a significantly shorter median (interquartile range) wait time to rheumatologist consult: 37.0 (24.5-55.5) days compared to non-expedited patients [105 (71.0-135.0) days] and controls [58.0 (24.0-104.0) days]. Accuracy comparing the ERP identification of IA/SARD to that of the rheumatologists was fair (κ 0.39, 95% CI 0.25-0.53). CONCLUSION Patients triaged and expedited by ERP experienced shorter wait times compared to usual care; however, some patients with IA/SARD were missed and waited longer. Our findings suggest that ERP working in a triage role can improve access to care for those patients correctly identified with IA/SARD. Further research needs to identify an ongoing ERP educational process to ensure the success of the model.
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Affiliation(s)
- Vandana Ahluwalia
- From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society. .,V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto.
| | - Sydney Lineker
- From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society.,V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto
| | - Raquel Sweezie
- From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society.,V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto
| | - Mary J Bell
- From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society.,V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto
| | - Tetyana Kendzerska
- From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society.,V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto
| | - Jessica Widdifield
- From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society.,V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto
| | - Claire Bombardier
- From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society.,V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto
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Lu MC, Koo M, Lai NS. Clinimetric properties of the Chinese version of the early inflammatory arthritis detection tool. BMC Musculoskelet Disord 2015; 16:243. [PMID: 26346703 PMCID: PMC4562197 DOI: 10.1186/s12891-015-0706-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely rheumatologic referral and management are crucial for patients with potential inflammatory arthritis. To meet this need, tools such as the early inflammatory arthritis (EIA) detection tool was developed and has been evaluated in Western populations. The aims of this study were to translate the English version of the EIA detection tool to Chinese and to determine its clinimetric properties in Taiwanese patients. METHODS Twenty controls and 111 patients with established diagnosis of osteoarthritis, rheumatoid arthritis, systemic autoimmune diseases, psoriatic arthritis, and ankylosing spondylitis were recruited from a regional hospital in south Taiwan. Multivariate logistic regression analysis was used to evaluate the independent and significant variables associated with diagnosis by rheumatologists. A prediction model was also developed for differentiating between patients with inflammatory arthritis and those with non-inflammatory arthritis musculoskeletal conditions. RESULTS The Chinese version of the EIA detection tool showed acceptable internal consistency (KR-20 coefficient 0.78) and test-retest reliability (κ statistic ranged from 0.43 to 0.94). A prediction model consisting of three EIA detection tool items (joint pain, swelling in hands or wrists, and ever been told to have rheumatoid arthritis) and sex was able to differentiate inflammatory arthritis and non-inflammatory arthritis musculoskeletal conditions with a sensitivity of 0.84, a specificity of 0.86, a positive predictive value of 0.92, and a negative predictive value of 0.76. CONCLUSIONS The Chinese version of the EIA detection tool showed good clinimetric properties in this study population and it can be used to differentiate Taiwanese patients with inflammatory arthritis and non-inflammatory arthritis musculoskeletal conditions.
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Affiliation(s)
- Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2 Minsheng Road, Dalin, 62247, Taiwan. .,School of Medicine, Tzu Chi University, Hualien City, Taiwan.
| | - Malcolm Koo
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Ning-Sheng Lai
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2 Minsheng Road, Dalin, 62247, Taiwan. .,School of Medicine, Tzu Chi University, Hualien City, Taiwan.
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