Lupus Education Advancement Project (LEAP): Rheumatology Fellows Serving As Educators Increased Knowledge and Efficiency in Lupus Recognition and Referral By Providers in Primary and Emergency Care

Diane Gross¹, Amy Caron², Irene Blanco³, Alfred Denio⁴, Sheetal Desai⁵, Amanda Sammut⁶ and Zoon Naqvi⁷, ¹S.L.E. Lupus Foundation/Lupus Research Institute, New York, NY, ²Lupus Research Institute, Ny, NY, ³Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, ⁴Rheumatology, Geisinger Medical Center, Danville, PA, ⁵Medicine/Rheumatology, Unviersity of California, Irvine, Orange, CA, ⁶NYC Health and Hospitals/Harlem Hospital Center and Columbia University Medical Center, New York, NY, ⁷Albert Einstein College of Medicine, Bronx, NY

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Education, educational research and health disparities, Lupus, medical, Referrals

Session Information

Date: Monday, November 14, 2016

Title: ARHP III: Education and Community Programs

Session Type: ARHP Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Primary and emergency care providers may have received 45 minutes of lupus education in medical school. Providers may fail in recognizing lupus because symptoms are often vague, delaying referrals and diagnosis for 2-6 years. Delay can lead to accrual of organ damage and death, which is more prevalent in minority populations. Many patients are referred to rheumatology not meeting assessment criteria for lupus, creating barriers to rheumatology care for urgent patients. The goal of LEAP is to increase lupus knowledge and improve lupus assessment and referral procedures among primary and emergency providers within the healthcare system.

Methods : LEAP enlisted rheumatology fellows to serve as educators to deliver a 1 Continuing Medical Education credit seminar. Four sites were selected based on commitment from Rheumatology Fellowship Program Directors or previous experience with the Teaching Fellows in Lupus Project, after which LEAP was modeled. Sites identified a problem in lupus referrals and included ways to address the problem in the seminar. Examples of problems in referrals that were addressed in the seminar include 1) ANA titer not included in the referral; 2) patients referred with only a positive ANA and no relevant clinical symptoms included; 3) consults with rheumatology conducted prior to issuing a formal referral. Rates will be analyzed to assess if the seminar changed behavior. Voluntary, anonymous pre/post assessments were used to evaluate changes in knowledge and behavior and collect qualitative data. A t-test was used to analyze independent group means.

Results: Preliminary data from 427 assessments were analyzed on a 9-point scale. Total mean score increased 2.10 immediately post seminar and 2.88 points at 4-6 weeks post seminar (p<.01). Over 85% reported the 1) activity improved medical or practice knowledge and 2) they would make changes that will benefit patient care. Respondents are considering lupus more at 4-6 weeks post seminar.

Conclusion: Rheumatology fellows can increase knowledge and promote behavior change in lupus assessment and referral among primary and emergency providers. LEAP may be an effective strategy to reduce health disparities in lupus.

Table 1. Knowledge Change Pre/Post/4-6 Weeks Post Seminar
Assessment (Group Data)	N	Mean Score (SD)	Mean Score Change from Pre Assessment	P-Value
Pre Seminar	208	5.07 (2.38)	n/a	<.01
Post Seminar	199	7.17 (1.45)	2.10	<.01
4-6 Weeks Post Seminar	20	7.95 (1.90)	2.88	<.01

Table 2. Sustained Behavior Changes
Matched Assessments Pre to 4-6 Weeks Post	N=15
Question	Pre %	4-6 Weeks Post %
1) You consider lupus in your differential diagnosis during an exam?
Very Often	0 (0.0)	11 (73.3)
Somewhat Often	3 (20.0)	3 (20.0)
Not Very Often	1 (6.7)	1 (6.7)
Not At All	11 (73.3)	0 (0.0)
2) You refer patients to the rheumatologist for suspected lupus?
Extensively	1 (6.7)	12 (80.0)
Significantly	0 (0.0)	1 (6.7)
Occasionally	3 (20.0)	1 (6.7)
Seldom	0 (0.0)	1 (6.7)
Never	11 (73.3)	0 (0.0)
3) You refer patients to lupus educational material or other educational resources?
Always	0 (0.0)	11 (73.3)
Often	0 (0.0)	1 (6.7)
Occasionally	0 (0.0)	1 (6.7)
Rarely	3 (20.0)	2 (13.3)
Never	12 (80.0)	0 (0.0)

Disclosure: D. Gross, None; A. Caron, None; I. Blanco, None; A. Denio, None; S. Desai, None; A. Sammut, None; Z. Naqvi, None.

To cite this abstract in AMA style:

Gross D, Caron A, Blanco I, Denio A, Desai S, Sammut A, Naqvi Z. Lupus Education Advancement Project (LEAP): Rheumatology Fellows Serving As Educators Increased Knowledge and Efficiency in Lupus Recognition and Referral By Providers in Primary and Emergency Care [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/lupus-education-advancement-project-leap-rheumatology-fellows-serving-as-educators-increased-knowledge-and-efficiency-in-lupus-recognition-and-referral-by-providers-in-primary-and-emergency-care/. Accessed .

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