Background/Purpose

Quantitative measures of disease activity are associated with improved outcomes for patients with rheumatoid arthritis (RA), but many rheumatologists continue to rely on non-quantitative assessments. The Dartmouth-Hitchcock Medical Center (DHMC) electronic health record (EHR) does not currently support patient-reported outcome measures (PROMs) to assess RA activity that can be searched and aggregated for patient care, research, or system-based quality improvement. The Routine Assessment of Patient Index Data 3 (RAPID 3) is a validated PROM which evaluates physical function, pain and global health. To integrate the RAPID 3 into routine clinical practice, an electronic version was built to allow patients to complete the RAPID3 through the EHR. Because we could not replicate the exact visual presentation of the RAPID 3 in the EHR, the aim of this study was to demonstrate equivalence between the electronic RAPID 3 and the validated paper version.

Methods

From March to June 2014, patients in the Rheumatology clinic age ≥ 18 years with seropositive or  seronegative RA were identified. All participants were active users of the web-based patient portal of the EHR. The electronic RAPID 3 was sent via the patient portal to each participant 1 week prior to their  appointment. Patients were notified electronically and by phone to complete the survey. The RAPID 3 paper version was administered on the day of their clinic visit. The first 50 patients to complete both versions were included. The EHR automatically calculates and interprets the disease activity score (scale 0-30: >12 high; 6.1-12 moderate; and 3.1-6 low; ≤3 remission). Paper surveys were scored manually. A paired t-test was used to compare samples with p values of ≤0.05 considered significant. The study was exempt from review by the Committee for the Protection of Human Subjects at Dartmouth College.

Results

Of the 50 patients included in the study, 33 (66%) were female and the average age was 58.8 years (±12.27).  An average of 4.2 days passed between the assessments. The mean total RAPID 3 scores for the paper and EHR versions were 9.57(SD±6.45) and 9.75 (SD±6.46) respectively. There were no statistically significant differences between the mean total RAPID3 of the paper and electronic versions (p=0.46), or each component score (table 1).

Table 1. Comparison of paper and EHR versions of RAPID3.

	Mean (±Standard Deviation)		paired t- test p value
	Paper	EHR
Physical Function	1.87(1.91)	1.85 (1.83)	0.85
Dress yourself	0.40 (0.64)	0.42 (0.67)	0.36
Get in and out of bed	0.46 (0.61)	0.34 (0.59)	0.41
Lift full cup or glass to mouth	0.20 (0.53)	0.18 (0.56)	0.37
Walking outdoors on flat ground	0.40 (0.67)	0.40 (0.67)	0.50
Wash and dry your entire body	0.42 (0.64)	0.48 (0.68)	0.36
Bend down to pick up clothing from floor	0.48 (0.68)	0.50 (0.68)	0.50
Turn regular faucet on and off	0.20 (0.53)	0.20 (0.53)	0.50
Get in and out of a car, bus, train or airplane	0.54 (0.65)	0.50 (0.58)	0.23
Walk two miles or three kilometers, if you wish	1.20 (1.18)	1.20 (1.20)	0.46
Participate in recreational activities and sports	1.28 (1.03)	1.34 (1.08)	0.37
Pain Score	3.86 (2.64)	4.03 (2.65)	0.27
Patient Global Assessment	3.84 (2.75)	3.87 (2.80)	0.65
Total	9.57 (6.45)	9.75 (6.46)	0.46

 Conclusion

There was no significant difference in responses between the electronic and paper versions. The electronic RAPID3 (built in an Epic system v2010) can and should be included in the care of all RA patients without interrupting clinic flow, and will facilitate research and systems-based practice improvement.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-the-measurement-of-disease-activity-for-patients-with-rheumatoid-arthritis-validation-of-an-electronic-version-of-the-routine-assessment-of-patient-index-data-rapid-3/