Session Title: Vasculitis
Session Type: Abstract Submissions (ACR)
The Birmingham Vasculitis Activity Score (BVAS) and Vasculitis Damage Index (VDI) are validated clinical assessment tools for the systemic vasculitides. However use of BVAS and VDI is limited, partly due to lack of training but also lack of perceived need. The increasing use of biological agents in vasculitis means that BVAS and VDI can provide quantifiable evaluation prior to treatment and be used to monitor response and outcome. We aimed to develop and test an online training tool for clinicians managing vasculitis patients and allow certification of clinical assessment in vasculitis. We present pilot data on the performance of this training package.
The training package (which consists of an introductory lecture, a manual plus 20 simple and 40 advanced vasculitis case scenarios selected from a large pool of cases) has been extensively used for clinical trials. Historically we have used paper cases; most recently 51 participants scored 3060 cases manually. We built an online customized interactive web-based application and tested it amongst a group of international physicians and research nurses specialized in vasculitis during 3 clinical trial investigators’ meetings, and one educational meeting for UK rheumatology fellows. The overall pass mark for each set of cases was set at 85% and 75% agreement with gold standard for BVAS and VDI respectively (and at least 50% for each individual case). In case of failure to achieve the required mark, cases could be reset allowing reattempts. The application provided immediate formal evaluation on completion and detailed feedback on performance of each evaluated case. We analyzed the percentage agreement, number of attempts per case and time needed to complete the training by each observer, as well as their own feedback.
Over the course of 4 events 3980 cases were scored online by 78 participants; 33.3% passed the advanced section on their first attempt. The number of reattempts per BVAS case decreased from 1.08 (1 in 14 cases retaken) in the introductory set to 1.05 (1 in 21 cases retaken) in the advanced set, showing intra-training improvement. Median time to complete a case was 4.18 (IQR 2.50-6.67) minutes and there was a trend showing a decrease in time taken per case as the participants progressed through the cases. The average mark at completion was 92.3% (range 86.6-96.4) for BVAS and 92% (range 88.9-95.0) for VDI. Overall 100% completed the training and were awarded certification. 59.2% of participants agreed that the training should be mandatory for all doctors who treat vasculitis patients.
We have developed a web-based training package to enhance clinicians’ ability to evaluate patients with systemic vasculitis, based on assessment of BVAS and VDI. This package is easy to use, feasible and acceptable to participants to facilitate their ability to manage patients with vasculitis, although its effectiveness needs to be validated in clinical setting. Currently we are expanding the number of cases based on clinical data from observational studies to allow for randomized case selection and retakes using different clinical scenarios.
GSK, Nordic, Chemocentryx, Roche, Nippon Kayaku,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/standardisation-of-disease-assesment-in-systemic-vasculitis-use-of-a-novel-web-based-software-training-application/