The complexity of care for patients with rheumatoid arthritis: metrics for better understanding chronic disease care.

The complexity of care for patients with rheumatoid arthritis: metrics for better understanding chronic disease care. Research Abstract Details 

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The complexity of care for patients with rheumatoid arthritis: metrics for better understanding chronic disease care. Abstract Text:

Katherine L Kahn,Catherine H MacLean,Honghu Liu,Laurence Z Rubenstein,Andrew L Wong,Judith O Harker,Wen-Pin Chen,Diane M Fitzpatrick,Ken J Bulpitt,Shana B Traina,Brian S Mittman,Bevra H Hahn,Harold E Paulus,

BACKGROUND: Patients with rheumatoid arthritis (RA) provide an important opportunity for understanding care of patients with a serious chronic condition. OBJECTIVES: We sought to characterize the complexity of care for patients with RA, including metrics describing the patient, the disease, and use of the health care system across time and place. METHODS: We undertook a prospective cohort study of 568 community-dwelling patients with RA by using observational data from clinically detailed telephone interviews at baseline and 2 years later in addition to medical record abstraction. Health status, comorbidity, use of disease-modifying antirheumatic drugs, visits, providers, provider types, encounter settings, and the discontinuity between patients and providers were studied. RESULTS: Within a 12-month window, 568 patients had 8686 outpatient encounters with the health care system with a mean of 3.41 unique providers per patient associated with a mean of 5 primary care and 6 rheumatologist visits. Half did not see a primary care physician, and 20% did not see a rheumatologist during 6-month periods despite their use of potentially toxic drugs, a mean of 4 comorbidities and progressive RA. Over the course of 24 months, 29% of patients changed their primary care provider, and 15% changed their rheumatologist. Patients were moderately impaired with mean SF-12 physical component score 37 (SD, 9). CONCLUSION: Patients with RA have frequent encounters with multiple providers and also frequent discontinuity of care. Recognizing the complexity of the care of patients with a chronic disease across multiple dimensions provides an opportunity to better understand challenges and opportunities in delivering high quality care.

The complexity of care for patients with rheumatoid arthritis: metrics for better understanding chronic disease care. Publishing Authors By Initials

KL Kahn,CH MacLean,H Liu,LZ Rubenstein,AL Wong,JO Harker,WP Chen,DM Fitzpatrick,KJ Bulpitt,SB Traina,BS Mittman,BH Hahn,HE Paulus,

For similar health occupations: medicine: specialties, medical research abstracts see: health occupations: medicine: specialties, medical research

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The complexity of care for patients with rheumatoid arthritis: metrics for better understanding chronic disease care. Journal Published:

PUBLICATION TYPE: Research Support, U.S. Gov't,

Journal: Medical care

VOLUME: 45

Page Numbers: 55-65

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ISSN: 0025-7079

DAY: 3

MONTH: Jan

YEAR: 2007

The complexity of care for patients with rheumatoid arthritis: metrics for better understanding chronic disease care. Information

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LANGUAGE: eng

NlmUniqueID: 230027

The complexity of care for patients with rheumatoid arthritis: metrics for better understanding chronic disease care. Keywords Mesh Terms:

KEYWORDS: Specialties, Medical

MESH TERMS: statistics & numerical data

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Grant and Affiliation Information for The complexity of care for patients with rheumatoid arthritis: metrics for better understanding chronic disease care.

AFFILIATION: University of California at Los Angeles, Greater Los Angeles VA Healthcare System, Los Angeles, California 90095-1736, USA. kkahn@mednet.ucla.edu

Country: United States

AGENCY: United States NIAMS

GRANT: 5 P60 AR36834

ACRONYM: AR

MEDLINETA: Med Care

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