Triage of Rheumatology Referrals Facilitates Wait Time Benchmarks

Farrer, Chandra; Abraham, Liza; Jerome, Dana; Hochman, Jacqueline; Gakhal, Natasha

doi:10.3899/jrheum.151235

Cited by 16 publications

(11 citation statements)

References 7 publications

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“…Recent evidence exclusively involving ACPAC-ERPs performing triage of patients with suspected IA in this type of model of care showed significant improvement on access-to-care. 21 , 22 This model still requires a rheumatologist’s assessment to make a diagnosis and create a treatment plan. Once a treatment plan is established, patients with IA can then be co-managed by the rheumatologist and an appropriately trained and skilled arthritis care provider such as an ACPAC-ERP.…”

Section: Introductionmentioning

confidence: 99%

“…The need for improved access to care has been the catalyst for the development of novel allied health practitioner roles [17][18][19] that can be locally developed, refined, and delivered throughout the continuum of care. More efficient models of care involving these trained health professionals have been shown to effectively triage patients with IA [20][21][22] and increase capacity for new and stable patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

An Advanced Clinician Practitioner in Arthritis Care (ACPAC) Maintains a Positive Patient Experience While Increasing Capacity in Rheumatology Community Care

Ahluwalia¹,

Inrig

Larsen³

et al. 2021

JMDH

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Purpose This study describes patient care experiences of solo-rheumatologist and co-managed care models utilizing an Advanced Clinician Practitioner in Arthritis Care-trained Extended Role Practitioner (ACPAC-ERP) in three community rheumatology practices. Materials and Methods Patients with inflammatory arthritis (IA) were assigned to care provided by one of three (2 senior, 1 early-career) community-based rheumatologists (usual care), or an ACPAC-ERP (co-managed care) for the 6-months following diagnosis. Patient experiences were surveyed using validated measures of patient satisfaction (Patient Doctor Interaction Scale-PDIS), global ratings of confidence and satisfaction, referral patterns, disease activity (RADAI) and self-perceived disability (HAQ-Disability) as well as demographic information. Practice capacity was evaluated 18-months prior to, and across, the study period. Results Of 55 participants (mean age 56.6 years, 61.8% female), 33 received co-managed care. Most participants were diagnosed with rheumatoid arthritis (65.5%) with a median symptom duration of 1.1 years. At 6-months, patients from both models of care were equally satisfied in terms of the information provided (usual care 4.6 vs co-managed care 4.7/5=greater satisfaction), rapport with health-care provider (4.6 vs 4.6/5) and having needs met (4.7 vs 4.5/5). Overall satisfaction was high (87.2 vs 85.3/100=completely satisfied) as was confidence in the system by which care was received (85.0 vs 82.1/100=completely confident). Usual care patients reported higher perceived disability than co-managed patients (HAQ-Disability 0.5 vs 0.2/3=unable to do). Significant differences in overall RADAI score (p=0.014) were found between the two models. The senior rheumatologist, with a previously saturated practice, attained a 37% capacity increase for new patients utilizing the co-managed care model. Conclusion The ACPAC-ERP model was equivalent to the solo-rheumatologist model with regard to patient experience and satisfaction. A co-management model utilizing a highly trained ACPAC-ERP can increase capacity in community rheumatology clinics for patients newly diagnosed with IA while maintaining confidence and satisfaction with their care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An Advanced Clinician Practitioner in Arthritis Care (ACPAC) Maintains a Positive Patient Experience While Increasing Capacity in Rheumatology Community Care

Ahluwalia¹,

Inrig

Larsen³

et al. 2021

JMDH

View full text Add to dashboard Cite

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“…Graduates of the ACPAC program21 represent a new cadre of practitioners, having received additional training at the postlicensure level and undergone formal evaluation to establish competency in advanced assessment, diagnosis, and management of select arthritic conditions 18. Their roles have been evaluated and described in a global construct at the health services level, with favourable outcomes for the patient15 as well as at clinical utilization and early system integration and change levels 13,14,19,22–24…”

Section: Introductionmentioning

confidence: 99%

An advanced clinician practitioner in arthritis care can improve access to rheumatology care in community-based practice

Ahluwalia¹,

Larsen²,

Kennedy

et al. 2019

JMDH

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ObjectiveTo facilitate access and improve wait times to a rheumatologist’s consultation, this study aimed to 1) determine the ability of an advanced clinician practitioner in arthritis care (ACPAC)-trained extended role practitioner (ERP) to triage patients with suspected inflammatory arthritis (IA) for priority assessment by a rheumatologist and 2) determine the impact of an ERP on access-to-care as measured by time-to-rheumatologist-assessment and time-to-treatment-decision.Materials and methodsA community-based ACPAC-trained ERP triaged new referrals for suspected IA. Patients with suspected IA were booked to see the rheumatologist on a priority basis. Diagnostic accuracy of the ERP to correctly identify priority patients; the level of agreement between ERP and rheumatologist (Kappa coefficient and percent agreement); and the time-to-treatment-decision for confirmed cases of IA were investigated. Retrospective chart review then compared time-to-rheumatologist-assessment and time-to-treatment-decision in the solo-rheumatologist versus the ERP-triage model.ResultsOne hundred twenty-one patients were triaged. The ERP designated 54 patients for priority assessment. The rheumatologist confirmed IA in 49/54 (90.7% positive predictive value [PPV]). Of the 121 patients, 67 patients were designated as nonpriority by the ERP, and none were determined to have IA by the rheumatologist (100% negative predictive value [NPV]). Excellent agreement was found between the ERP and the rheumatologist (Kappa coefficient 0.92, 95% CI: 0.84–0.99). In the ERP-triage model, time-from-referral-to-treatment-decision for patients with IA was 73.7 days (SD 40.4, range 12–183) compared with 124.6 days (SD 61.7, range 26–359) in the solo-rheumatologist model (40% reduction in time-to-treatment-decision).ConclusionA well-trained and experienced ERP can shorten the time-to-Rheumatologist-assessment and time-to-treatment-decision for patients with suspected IA.

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“…5 To cope with these issues, some rheumatology practices have limited the number of referrals they accept and implemented strategies designed to improve triage, such as restrictions on accepted diagnoses, centralized intake and standardized referral forms. [5][6][7][8] Unfortunately, these measures can lead to more declined referrals, which cause a greater burden for patients.One solution in Eastern Ontario is the Champlain BASE (Building Access to Specialists Through eConsultation) eConsult Service, an asynchronous, secure Web-based appli-cation that allows primary care providers to submit patientspecific clinical questions to multiple specialty services, including rheumatology. 9,10 User satisfaction is high, with primary care providers commonly citing the service's promptness, quality of replies and added education from specialist…”

mentioning

confidence: 99%

mentioning

confidence: 99%

A comparison of faxed referrals and eConsult questions for rheumatology referrals: a descriptive study

Keely

Rostom

Smith

et al. 2021

cmajo

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he number of patients requiring care from a rheumatologist has increased in recent years, while the number of rheumatologists available to provide clinical care remains inadequate and static. [1][2][3] In Canada, studies have found substantial variability in wait times for rheumatology. A study assessing time to first rheumatologist visit in new rheumatoid arthritis reported a mean wait time of 77 days, with a median wait time of 50 days. 4 Another study reported a mean wait time of 155 (standard deviation 88) days for routine rheumatology referrals. 5 To cope with these issues, some rheumatology practices have limited the number of referrals they accept and implemented strategies designed to improve triage, such as restrictions on accepted diagnoses, centralized intake and standardized referral forms. [5][6][7][8] Unfortunately, these measures can lead to more declined referrals, which cause a greater burden for patients.One solution in Eastern Ontario is the Champlain BASE (Building Access to Specialists Through eConsultation) eConsult Service, an asynchronous, secure Web-based appli-cation that allows primary care providers to submit patientspecific clinical questions to multiple specialty services, including rheumatology. 9,10 User satisfaction is high, with primary care providers commonly citing the service's promptness, quality of replies and added education from specialist

show abstract

Triage of Rheumatology Referrals Facilitates Wait Time Benchmarks

Abstract: Centralized triage of rheumatology referrals and quality improvement initiatives are effective in improving wait times for priority patients as determined by paper referral.

Cited by 16 publications

References 7 publications

An Advanced Clinician Practitioner in Arthritis Care (ACPAC) Maintains a Positive Patient Experience While Increasing Capacity in Rheumatology Community Care

An Advanced Clinician Practitioner in Arthritis Care (ACPAC) Maintains a Positive Patient Experience While Increasing Capacity in Rheumatology Community Care

An advanced clinician practitioner in arthritis care can improve access to rheumatology care in community-based practice

A comparison of faxed referrals and eConsult questions for rheumatology referrals: a descriptive study

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