Rice Alexandra Lauren, Gillespie Sarah, Sai Nikhil, Reddy Soumya M, Merola Joseph F, Haberman Rebecca H, Ogdie Alexis, Scher Jose U
NYU Grossman School of Medicine, New York, NY, USA.
Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
J Psoriasis Psoriatic Arthritis. 2025 Jul 14:24755303251361800. doi: 10.1177/24755303251361800.
In order to apply current treatment recommendations for psoriatic arthritis (PsA), a complete assessment of psoriatic disease domains must be completed by the clinician. This includes a musculoskeletal examination (including tender and swollen joints, dactylitis, enthesitis, and axial disease) as well as skin and nail examination. Documentation in the clinician's note serves as a proxy for disease assessment.
To explore differences in documentation of psoriatic domains between PsA specialist and general rheumatologists at 2 academic centers.
We identified PsA patients seen by either general rheumatologists or by PsA combined clinic specialist providers at 2 established PPACMAN (Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network) sites. Records were assessed for the presence (and extent) of documentation for musculoskeletal and cutaneous PsA domains. We also examined accuracy of ICD coded diagnoses to understand the extent to which discrete data from the electronic medical record can be used to evaluate completeness of assessment.
PsA combined clinic specialist providers documented disease domains significantly more consistently compared to generalists, including tender and swollen joint counts ( < 0.001), assessment of spondyloarthritis ( = 0.017), and presence/extent of skin involvement ( < 0.001). Additionally, PsA specialists more consistently coded for both psoriasis (PsO) and PsA.
In this multicenter, retrospective study, compared to generalists, PsA combined-clinic specialist providers more thoroughly documented both musculoskeletal and cutaneous psoriatic disease domains and ICD coding of PsO for patients, highlighting gaps in assessment and documentation. These findings underscore the need for improved training in psoriatic disease assessment and simplified modalities for documentation.
为了应用当前银屑病关节炎（PsA）的治疗建议，临床医生必须完成对银屑病疾病领域的全面评估。这包括肌肉骨骼检查（包括压痛和肿胀关节、指（趾）炎、附着点炎和轴向疾病）以及皮肤和指甲检查。临床记录中的文件可作为疾病评估的替代指标。
探讨两个学术中心的PsA专科医生和普通风湿病学家在银屑病领域记录方面的差异。
我们在两个已建立的PPACMAN（银屑病和银屑病关节炎诊所多中心推进网络）站点中，确定了由普通风湿病学家或PsA联合诊所专科医生诊治的PsA患者。评估记录中肌肉骨骼和皮肤PsA领域的记录情况（及范围）。我们还检查了ICD编码诊断的准确性，以了解电子病历中的离散数据可用于评估评估完整性的程度。
与普通医生相比，PsA联合诊所专科医生对疾病领域的记录明显更一致，包括压痛和肿胀关节计数（<0.001）、脊柱关节炎评估（=0.017）以及皮肤受累情况（<0.001）。此外，PsA专科医生对银屑病（PsO）和PsA的编码也更一致。
在这项多中心回顾性研究中，与普通医生相比，PsA联合诊所专科医生对患者的肌肉骨骼和皮肤银屑病疾病领域以及PsO的ICD编码记录更为全面，突出了评估和记录方面的差距。这些发现强调了在银屑病疾病评估方面改进培训以及简化记录方式的必要性。
