From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society.
V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto.
J Rheumatol. 2020 Mar;47(3):461-467. doi: 10.3899/jrheum.180734. Epub 2019 Jun 1.
We evaluated the influence of triage assessments by extended role practitioners (ERP) on improving timeliness of rheumatology consultations for patients with suspected inflammatory arthritis (IA) or systemic autoimmune rheumatic diseases (SARD).
Rheumatologists reviewed primary care providers' referrals and identified patients with inadequate referral information, so that a decision about priority could not be made. Patients were assessed by an ERP to identify those with IA/SARD requiring an expedited rheumatologist consult. The time from referral to the first consultation was determined comparing patients who were expedited to those who were not, and to similar patients in a usual care control group identified through retrospective chart review.
Seven rheumatologists from 5 communities participated in the study. Among 177 patients who received an ERP triage assessment, 75 patients were expedited and 102 were not. Expedited patients had a significantly shorter median (interquartile range) wait time to rheumatologist consult: 37.0 (24.5-55.5) days compared to non-expedited patients [105 (71.0-135.0) days] and controls [58.0 (24.0-104.0) days]. Accuracy comparing the ERP identification of IA/SARD to that of the rheumatologists was fair (κ 0.39, 95% CI 0.25-0.53).
Patients triaged and expedited by ERP experienced shorter wait times compared to usual care; however, some patients with IA/SARD were missed and waited longer. Our findings suggest that ERP working in a triage role can improve access to care for those patients correctly identified with IA/SARD. Further research needs to identify an ongoing ERP educational process to ensure the success of the model.
我们评估了扩展角色从业者（ERP）的分诊评估对改善疑似炎症性关节炎（IA）或系统性自身免疫性风湿病（SARD）患者的风湿病咨询及时性的影响。
风湿病医生审查了初级保健提供者的转诊，并确定了转诊信息不足的患者，以至于无法做出优先考虑的决定。由 ERP 对患者进行评估，以确定需要紧急风湿病医生会诊的 IA/SARD 患者。通过比较优先转诊患者与非优先转诊患者，以及通过回顾性图表审查确定的常规护理对照组中类似患者，确定从转诊到第一次就诊的时间。
来自 5 个社区的 7 名风湿病医生参与了这项研究。在接受 ERP 分诊评估的 177 名患者中，有 75 名患者被加急，102 名患者未被加急。加急患者到风湿病医生就诊的中位（四分位距）等待时间明显缩短：37.0（24.5-55.5）天，而非加急患者为 105.0（71.0-135.0）天，对照组为 58.0（24.0-104.0）天。ERP 对 IA/SARD 的识别与风湿病医生的识别相比，准确性为中等（κ 0.39，95%CI 0.25-0.53）。
与常规护理相比，由 ERP 分诊和加急的患者等待时间更短；然而，一些患有 IA/SARD 的患者被漏诊并等待更长时间。我们的研究结果表明，ERP 在分诊角色中可以改善那些正确识别出患有 IA/SARD 的患者的获得护理的机会。需要进一步研究来确定持续的 ERP 教育过程，以确保该模型的成功。
