Background/Purpose: The integration of advanced practice providers (APPs) into rheumatology practice may help address increasing demand and long wait times.1 However, outcome data on APP involvement, particularly in procedural roles, remain limited. We report how ultrasound (US)-guided procedures performed by a newly hired APP in a high-volume, procedure-focused rheumatology musculoskeletal (MSKUS) clinic can enhance patient access to diagnostic and therapeutic interventions. 

Methods: CPT codes for US-guided procedures performed by a newly hired APP were tracked over a 7-month period (8/2023–3/2024). Prior to this period, the APP had 1 year of experience performing palpation-guided injections and completed a rheumatologic MSKUS training program emphasizing procedural guidance. The APP performed over 100 US-guided procedures under direct supervision before transitioning to independent practice. Procedures included US-guided aspiration and/or corticosteroid injection. CPT codes were used to classify procedures sites with US-guidance: large joint/bursa (20611), intermediate joint/bursa (20606), small joint (20604), tendon sheath (20550), and carpal tunnel (20526). Data were analyzed by frequency and percentage of total procedures performed. Associated clinical diagnoses were also collected.  

Results: Over the 7-month period, the APP performed a total of 284 US guided procedures during independently scheduled procedure clinics.  Of these, 59% (n=167) were large joints/bursae, 11% (n=32) involved intermediate joints/bursae, 25% (n=70) were small joint injections, 2% (n=7) involved tendon sheaths, and 3% (n=8) were carpal tunnel injections (Fig. 1). Indications for procedures included joint effusion, synovitis, bursitis, tendinitis and carpal tunnel syndrome. Underlying diagnoses among patients included inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, spondylarthritis), crystalline arthritis (gout, calcium pyrophosphate deposition disease), osteoarthritis, and mechanical overuse syndromes. Patient access improved to less than 2 weeks. 

Conclusion: In an early implementation phase, the majority of US-guided procedures performed by a novice APP involved large joints (e.g. shoulders, hips, and knees) and small joints (e.g. MCP, MTP, PIP), with large joints comprising over half of all procedures. These findings guide referral planning and scope expectations for APPs new to a rheumatology MSKUS procedure clinic. Ongoing assessments will evaluate the evolution of procedure types and volumes over time as the APP gains experience, providing further insight into the scope and capacity of APPs in performing US-guided procedures within rheumatology practice demonstrating impact on rheumatology workforce expansion and patient access. 

Table 1

« Back to ACR Convergence 2025

ACR Meeting Abstracts - https://acrabstracts.org/abstract/development-of-a-training-toolkit-to-support-advanced-practice-providers-apps-entry-into-a-rheumatology-musculoskeletal-ultrasound-subspecialty-clinic/