Background/Purpose:

The public database JointMan^TMwas launched January 2012 with a mission to provide a practical outcome tool to manage patients with RA in a clinical setting. This was not constructed as a research registry. The rheumatology community has been educated on the importance of measurement in patients with RA, but has not yet adopted the strict concept of treating to target; rather, in a real world setting rheumatologists may be measuring but not acting on their measurements.

In this observational study, the stated hypothesis is that rheumatologists who are consistently measuring are not yet treating to target and therefore not utilizing the obtained outcome measurements to attain a specific therapeutic goal.

Methods:

JointMan^TMcaptures RA diagnostic criteria and selected disease features, formal joint counts, MDHAQ, DAS 28, CDAI, SDAI, RAPID3, CRP and ESR, medication use, toxicities and reason for discontinuation.  This was a descriptive observational study.

Results:

To date 16 national providers have entered patients.  A total of 2465 unique RA patients and 6860 encounters were recorded between January 1, 2012 and December 31, 2012. Of the 2465 unique RA patients, 1862 patients had greater than one encounter reported. Only patients with greater than one encounter were evaluated. Demographic characteristics of this group revealed that 72 % were female, mean age was 62, 55 % were RF positive, 41 % were CCP positive, 34 % had documented erosions noted on radiographic studies.  

CDAI and RAPID3 scores were available for 83.4% and 91.73% respectively. The mean initial CDAI score was 14.01 at the time of first encounter and a mean CDAI score of 12.05 was noted at the time of the last encounter for a 1.96 improvement (13.98% improvement).  The mean initial RAPID3 score was 11.28 at the time of first and 10.94 was noted at the time of the last encounter for a 0.34 improvement (3.01% improvement).  The mean number of encounters per patient where CDAI and RAPID3 were recorded was 4.71 and 4.38 respectively.

Conclusion:

Utilizing a new database, JointMan^TM, constructed to easily enter patient data in a clinical setting, it was demonstrated that physicians in a real world setting consistently determine outcome measurements.  However, although there is a definite mean improvement in chosen outcome measurements, a mean low disease state is not achieved for this group of patients.

The primary purpose of objective measurement is quality improvement.  The optimal method to achieve this goal is to provide feedback through a real time data visualization tool. Having succeeded in educating physicians to actually obtain an outcome measurement consistently, there is now a need to more formally teach rheumatologist as to how to use the measurement to attain a desired disease state.

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatologists-who-are-consistently-using-an-objective-outcome-instrument-do-not-treat-to-target-in-a-real-world-setting/