Two-Year Impact of a Continuing Professional Education Program to Train Primary Care Providers to Perform Arthrocentesis

Michael J. Battistone¹, Andrea Barker¹, J. Peter Beck², Phillip Lawrence³ and Grant Cannon⁴, ¹Veterans Affairs Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, UT, ²Orthopaedics, Salt Lake City VA Medical Center and University of Utah, Salt Lake City, UT, ³Salt Lake City VA Medical Center and Roseman University of Health Sciences, Salt Lake City, UT, ⁴Salt Lake City VA Medical Center and University of Utah, Salt Lake City, UT

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Education, educational innovation, educational research, educator and primary care, medical

Session Information

Date: Sunday, November 5, 2017

Title: Education

Session Type: ACR Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: Initial reports of a local continuing professional education (CPE) program designed for primary care providers (PCPs) described an increase in in the number of joint injections performed by those who had participated in the training.(1) The aim of this study was to examine the magnitude and durability of this behavioral change in a larger, geographically diverse impact of cohort of primary care providers. Methods: Thirty-eight primary care providers (PCPs) from 28 VA clinics representing 15 states participated in the week-long MSK “Mini-Residency” which was held at the Salt Lake City VA periodically between April 2012 and October 2013. The number of de-identified procedure codes performed by participants over the 24-months prior to their matriculation in the mini-residency (pre-training) were reviewed, and compared to those performed 24-months following their participation (post-training). Differences in the numbers of procedure codes that were documented post-training as compared to pre-training were evaluated using paired Student’s t-test (2-tailed). Results: Thirty-four PCPs (25 MDs/Dos, 9 PAs/NPs—89% of the total number of trainees) were clinically active in primary care following the program. The mean number of injection codes per provider, as well as the ranges and standard deviations for the physician and non-physician provider groups at 2-years and 1-year prior to the training, as well as at 1- and 2-years post-training are presented in the Table below. Differences in these numbers, as well as the percent change from the preceding period of observation, are also shown:

			Mean Injections/yr (% 1-year change; p) [Range, s.d]
	N	2 Years Pre-Training Mean Injections/yr [Range, s.d.]	1 Year Pre-Training	1 Year Post-Training	2 Years Post-Training
MD/DO	25	12 [0-75, 20]	12 (0%; 0.92) [0-75, 18]	34 (183%; 0.02) [0-248, 54]	43 (26%; 0.26) [0-309, 81]

ARNP/PA	9	3 [0-12, 4]	3 (0%; 0.86) [0-12; 4]	16 (464%; 0.07) [2-54, 16]	43 (40%; 0.18) [2-74, 35]

Overall	34	10 [0-75, 17]	10 (0%; 0.96) [0-75, 16]	29 (205%; 0.004) [0-248, 48]	37 (28%; 0.17) [0-309, 71]

Conclusion: Results from the pilot program are confirmed at 2 years, showing sustained changes in clinical behavior, for both physician and non-physician provider groups. Substantial variance in the number of joint injections was observed across the participants, suggesting that after the training some providers expanded their clinical repertoire more than did others. These findings should inform decisions made by clinic managers and clinical leadership in selecting participants for a training opportunity designed to increase proficiency in joint injections. Additional investigation of the sources of variance in provider behavior following the mini-residency program is needed to better understand these results.

Reference List

1. Battistone MJ, Barker AM, Lawrence P, Grotzke MP, Cannon GW. Mini-Residency in Musculoskeletal Care: An Interprofessional, Mixed-Methods Educational Initiative for Primary Care Providers. Arthritis Care Res (Hoboken). 2016;68(2):275-9.

Disclosure: M. J. Battistone, None; A. Barker, None; J. P. Beck, None; P. Lawrence, None; G. Cannon, Amgen, 2.

To cite this abstract in AMA style:

Battistone MJ, Barker A, Beck JP, Lawrence P, Cannon G. Two-Year Impact of a Continuing Professional Education Program to Train Primary Care Providers to Perform Arthrocentesis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/two-year-impact-of-a-continuing-professional-education-program-to-train-primary-care-providers-to-perform-arthrocentesis/. Accessed .

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