Background/Purpose: The implementation of a major program to improve the quality of care in inflammatory arthritides (rheumatoid arthritis-RA, spondyloarthritis- SpA and psoriatic arthritis- PsA) included the increased use of biologics and shifting clinically appropriate cases from inpatient to outpatient care, in response to patient preferences. These changes led to a significant improvement in patient outcomes, reductions in the number of inpatient days of care, and increases in the use of outpatient care. This is the first study to examine the reimbursement and patient outcome implications of this quality improvement program, which is similar to other programs being implemented across Norway and internationally. The aim of this study is to examine quantitatively the changes in reimbursements and patient outcomes associated with this programmatic change in inflammatory arthritides.

Methods: This prospective observational study was performed at the Department of Rheumatology, Hospital for Rheumatic Diseases in Haugesund, Norway. Before May 2016 the Department of Rheumatology required 22 inpatient beds. After 1 May 2015 the quality improvement program was implemented, including a major switch from inpatient to outpatient healthcare, and the number of beds required was reduced to 6. The Diagnosis related group (DRG) system was used to measure the clinical production of the department for the period from May 1 to December 31, 2015 and compare it to the same period in 2014. One DRG point is reimbursed at 21 000 Norwegian Krones (US$2520). The mean Modified Health Assessment Questionnaire (MHAQ) for patients with RA and PsA and mean BASFI (Bath Ankylosing Spondylitis Functional Index) for SpA were used as outcome measures indicating the quality of care provided.

Results: From May 1 to December 31 2014, 981 admissions were recorded, while during the same period in 2015 the number was reduced to 534. The production of the inpatient unit from May 1 to December 31, 2014 was 871 DRG points while during the same period in 2015 production was reduced to 623 DRG points. The number of outpatient clinic consultations increased from 4 397 in during the same period of 2014 to 5 588 in during the comparable period in 2015 and the number of DRG points increased from 539 to 654, respectively. The mean MHAQ (RA and PsA) and mean BASFI (SpA) at the end of December 2015 were 0.47 and 3, respectively, while in December 2014 the comparable measures were 0.47 and 3, respectively (p=1 and p=0.9). In total 2 800 000 NOK (335 000 USD) was saved during the study period compared to 2014.

Conclusion: Switching from inpatient to outpatient care for patients with inflammatory arthritides leads to lower costs and reduced number of medical errors without any reductions in quality of health care provided. These encouraging results should be further confirmed in larger studies.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/transforming-healthcare-in-rheumatology-from-inpatient-to-outpatient-care-without-reductions-in-healthcare-quality/