Evaluating Factors Associated With Telehealth Appropriateness in Outpatient Rheumatoid Arthritis Encounters Using the Encounter Appropriateness Score for You (EASY).
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2024-06
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Abstract
Objective
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.Methods
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.Results
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).Conclusion
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.Type
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Smith, Isaac D, Mary J Solomon, Hillary Mulder, Catherine Sims, Theresa M Coles, Robert Overton, Nicoleta Economou-Zavlanos, Rong Zhao, et al. (2024). Evaluating Factors Associated With Telehealth Appropriateness in Outpatient Rheumatoid Arthritis Encounters Using the Encounter Appropriateness Score for You (EASY). The Journal of rheumatology. pp. jrheum.2024–jrheum.0014. 10.3899/jrheum.2024-0014 Retrieved from https://hdl.handle.net/10161/31214.
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Scholars@Duke
Catherine Alexis Sims
My interest is in improving the delivery of preventative and reproductive health care for patients with autoimmune disease. As a rheumatology fellow, I was awarded a Women’s Health Fellowship grant to expand an international pregnancy registry for women with vasculitis (VPREG) and explore their lived experiences with pregnancy and breastfeeding. Through these efforts, we collaborated with a patient partner to create patient-focused resources (handouts, videos) on pregnancy and contraception that aim to foster shared decision making and patient empowerment. After completion of my rheumatology fellowship, I was selected for a Health Systems Research fellowship at the Durham Veterans Affairs (VA) Health Care System. During this fellowship, I was awarded an Internal Pilot grant to characterize pregnancy outcomes of Veterans with autoimmune disease from national Veteran data. In the second phase of this pilot, we are currently conducting interviews with women Veterans from minoritized populations to gain their perspective on preventative and reproductive health care access and facilitation of this care. Additionally, I am working with the Veterans Affairs Rheumatoid Arthritis (VARA) registry to assess completion and outcomes of cervical cancer screening in this higher risk population. During my clinical time, I have the opportunity to engage with patients in the Duke Autoimmunity in Pregnancy Clinic and VA rheumatology clinics as well as educate medical students, resident, fellows, and advanced practice providers. I am excited to continue advocating for preventative and reproductive health to improve delivery of comprehensive health care for patients with autoimmune disease.
Theresa Marie Coles
Theresa Coles, Ph.D., is a health outcomes methodologist with a focus on measuring and evaluating patient-reported outcomes (PROs) and other clinical outcomes assessments (COAs), integrating PRO measures in clinical care, and improving interpretation of patient-centered outcome scores for use in healthcare delivery and clinical research settings to inform decision making.
My research program is comprised of 3 pillars:
- Enhance the assessment of physical function and related concepts to inform decision-making
- Improve interpretability of PRO scores
- Design and implement screeners to improve patient-centered care by measuring what matters
Nicoleta Economou-Zavlanos
Director of Duke Health AI Evaluation and Governance
Founding Director of Algorithm-Based Clinical Decision Support (ABCDS) Oversight
Nicoleta Economou-Zavlanos, PhD, is the Director of the Duke Health AI Evaluation & Governance Program and the founding director of the Algorithm-Based Clinical Decision Support (ABCDS) Oversight initiative. In this capacity, she leads Duke Health’s efforts to evaluate and govern health AI technologies. Dr. Economou also serves on the Executive Committee of the NIH Common Fund’s Bridge to Artificial Intelligence (Bridge2AI) Program and as a Scientific Advisor for the Coalition for Health AI (CHAI), driving the development of guidelines for AI assurance in healthcare.
A nationally recognized expert in health AI governance, Dr. Economou has been instrumental in creating frameworks and methodologies for the registration, review, and assurance of health AI systems. Her research, published in leading journals such as NPJ Digital Medicine, JAMA, JAMA Health Forum, and JAMIA, reflects her commitment to advancing the responsible development and use of AI in healthcare.
Megan Elizabeth Bowles Clowse
Dr. Megan Clowse is an Associate Professor of Medicine and Chief of the Division of Rheumatology and Immunology; she also holds joint appointments in the Department of Obstetrics and Gynecology and Population Health Sciences. Her clinical research focuses on the management of rheumatic diseases in pregnancy. She has cared for over 1000 pregnancies in women with rheumatic disease, collecting information on these pregnancies initially in the Duke Autoimmunity in Pregnancy Registry and Repository, and the MADRA (Maternal Autoimmune Disease Research Alliance) registry and repository. She served on the Core Leadership Team for the inaugural American College of Rheumatology's Reproductive Health Guidelines, published January 2020. Dr. Clowse created www.LupusPregnancy.org and www.ReproRheum.Duke.edu, websites dedicated to improving pregnancy planning and management for patients and rheumatologists.
Dr. Clowse was the founding director of the Duke Lupus Clinic, where she continues to see patients each week and mentor junior faculty researchers. The team has developed a new approach to lupus classification and management and is currently collecting and analyzing patient- and physician-reported measures to better clarify this construct.
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
David Leverenz
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