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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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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Isaac David Smith
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.
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