I.D. Smith, MD, MSc, C. Sims, MD, Department of Medicine, Division of Rheumatology and Immunology, Duke University School of Medicine, and Department of Medicine, Division of Rheumatology, Durham Veterans Affairs Medical Center;
M.J. Solomon, MS, AI Health, Duke University School of Medicine, and Department of Biostatistics and Bioinformatics, Duke University School of Medicine.
J Rheumatol. 2024 Aug 1;51(8):759-764. doi: 10.3899/jrheum.2024-0014.
Telehealth has been proposed as a safe and effective alternative to in-person care for rheumatoid arthritis (RA). The purpose of this study was to evaluate factors associated with telehealth appropriateness in outpatient RA encounters.
A prospective cohort study (January 1, 2021, to August 31, 2021) was conducted using electronic health record data from outpatient RA encounters in a single academic rheumatology practice. Rheumatology providers rated the telehealth appropriateness of their own encounters using the Encounter Appropriateness Score for You (EASY) immediately following each encounter. Robust Poisson regression with generalized estimating equations modeling was used to evaluate the association of telehealth appropriateness with patient demographics, RA clinical characteristics, comorbid noninflammatory causes of joint pain, previous and current encounter characteristics, and provider characteristics.
During the study period, 1823 outpatient encounters with 1177 unique patients with RA received an EASY score from 25 rheumatology providers. In the final multivariate model, factors associated with increased telehealth appropriateness included higher average provider preference for telehealth in prior encounters (relative risk [RR] 1.26, 95% CI 1.21-1.31), telehealth as the current encounter modality (RR 2.27, 95% CI 1.95-2.64), and increased patient age (RR 1.05, 95% CI 1.01-1.09). Factors associated with decreased telehealth appropriateness included moderate (RR 0.81, 95% CI 0.68-0.96) and high (RR 0.57, 95% CI 0.46-0.70) RA disease activity and if the previous encounters were conducted by telehealth (RR 0.83, 95% CI 0.73-0.95).
In this study, telehealth appropriateness was most associated with provider preference, the current and previous encounter modality, and RA disease activity. Other factors like patient demographics, RA medications, and comorbid noninflammatory causes of joint pain were not associated with telehealth appropriateness.
远程医疗已被提议作为类风湿关节炎（RA）患者门诊治疗的一种安全有效的替代方法。本研究的目的是评估与门诊 RA 就诊中远程医疗适宜性相关的因素。
这是一项前瞻性队列研究（2021 年 1 月 1 日至 2021 年 8 月 31 日），使用单家学术风湿病诊所门诊 RA 就诊的电子健康记录数据进行。风湿病医生在每次就诊后立即使用适合您的就诊适宜性评分（Encounter Appropriateness Score for You，EASY）对其就诊的远程医疗适宜性进行评分。采用广义估计方程模型的稳健泊松回归分析评估远程医疗适宜性与患者人口统计学特征、RA 临床特征、关节痛的非炎症性合并症、既往和当前就诊特征以及医生特征的相关性。
在研究期间，25 名风湿病医生对 1177 名 RA 患者的 1823 次门诊就诊进行了 EASY 评分。在最终的多变量模型中，与远程医疗适宜性增加相关的因素包括医生在既往就诊中对远程医疗的偏好更高（相对风险 [RR]1.26，95%置信区间 [CI]1.21-1.31）、远程医疗作为当前就诊模式（RR2.27，95%CI1.95-2.64）和患者年龄增加（RR1.05，95%CI1.01-1.09）。与远程医疗适宜性降低相关的因素包括中度（RR0.81，95%CI0.68-0.96）和高度（RR0.57，95%CI0.46-0.70）RA 疾病活动度以及如果既往就诊是通过远程医疗进行的（RR0.83，95%CI0.73-0.95）。
在这项研究中，远程医疗适宜性与医生的偏好、当前和既往就诊模式以及 RA 疾病活动度最相关。其他因素，如患者人口统计学特征、RA 药物和关节痛的非炎症性合并症与远程医疗适宜性无关。
