Department of Medicine, Division of Rheumatology, Mount Sinai Medical Center, New York, New York 10029, USA.
Arthritis Care Res (Hoboken). 2011 Oct;63(10):1482-5. doi: 10.1002/acr.20539.
By 2030, the number of permanently homebound individuals in the US will increase by 50% to reach 2 million. However, no medicine subspecialty consult services exist for this rising subset of the population. This pilot program establishes a rheumatology consult service for the Mount Sinai Visiting Doctors, the largest primary care academic home visit program in the nation serving more than 1,000 patients in New York City. Our service addresses the unmet need for homebound patients with rheumatic diseases, and secondarily provides an educational opportunity for trainees in community-based rheumatology.
Using an electronic medical record, home-based primary care physicians sent consult requests to the Rheumatology Division. Initial assessments were made using the Routine Assessment of Patient Index Data 3 (RAPID3) questionnaire.
Over 12 months, 57 home visits were made: 31 new consults and 26 followup visits. Reasons for referral included medical management of a known connective tissue disease, question of inflammatory arthritis, and procedures. The demographics for new consults were as follows: 94% women, 45% Hispanic, and 80% between ages 60 and 101 years. Thirty-nine percent of patients had rheumatoid arthritis. Treatment interventions included addition of a disease-modifying antirheumatic drug in 11 patients, 11 procedures, nonpharmacologic management in 8 patients, and a change in the dose of the existing medication in 5 patients. At the initial evaluation, the average RAPID3 scores for patients reflected high severity of disease.
The number of consults and the severity of disease seen highlight the importance of a rheumatologist's role in the community, especially because the number of homebound patients will dramatically increase in the future.
到 2030 年，美国永久性居家患者的数量将增加 50%，达到 200 万。然而，目前还没有专门为这一不断增加的人群提供医学专业学术文献翻译为简体中文服务。本试点项目为西奈山访问医生设立了风湿病咨询服务，这是全国最大的初级保健上门项目，为纽约市的 1000 多名患者提供服务。我们的服务满足了居家风湿病患者的未满足需求，并为社区为基础的风湿病培训生提供了教育机会。
家庭医生通过电子病历向风湿病科发送咨询请求。使用常规评估患者指数数据 3（RAPID3）问卷进行初步评估。
在 12 个月内，进行了 57 次家访：31 次新咨询和 26 次随访。转诊的原因包括结缔组织疾病的医学管理、炎症性关节炎和程序问题。新咨询患者的人口统计学特征如下：94%为女性，45%为西班牙裔，80%年龄在 60 至 101 岁之间。39%的患者患有类风湿关节炎。治疗干预措施包括 11 名患者添加疾病修饰抗风湿药物、11 项程序、8 名患者非药物治疗和 5 名患者改变现有药物剂量。在最初的评估中，患者的平均 RAPID3 评分反映了疾病的严重程度。
咨询的数量和疾病的严重程度突出了社区风湿病医生的重要作用，尤其是因为未来居家患者的数量将大幅增加。
