Evaluation of the Impact of Telemedicine on Management of Rheumatoid Arthritis

 描述(申请人提供)：类风湿性关节炎(RA)是一种慢性自身免疫性疾病，主要影响关节，导致高致残率和死亡率增加。美洲印第安人/阿拉斯加原住民(AI/AN)人群的RA负担很高。治疗类风湿性关节炎的指南要求经常去看风湿科医生。在美国，风湿病医生短缺，这对少数民族和农村人口的影响不成比例。阿拉斯加在远程医疗创新方面一直处于领先地位，最近在多个农村诊所大幅提高了视频电话会议(VTC)能力。鉴于类风湿性关节炎的护理质量取决于风湿病医生的就诊情况，这项职业培训技术有望改善农村患者获得护理的机会，并提高护理质量。虽然远程医疗在世界各地的许多专科中的应用正在增加，但与实施远程医疗VTC随访相关的临床结果的数据有限。这项建议的目的是评估远程医疗风湿病VTC随访对RA护理质量的结果和过程措施的影响。中心假设是，远程医疗将与改善护理质量相关。这一假设将通过以下具体目的进行检验：具体目的1)确定远程医疗对疾病活动的影响，这是以患者为中心的类风湿性关节炎护理质量的结果衡量标准；以及具体目的2)调查远程医疗对类风湿性关节炎护理质量的过程衡量的影响。这项研究的设计是纳入风湿科医生在接受或不接受远程医疗VTC随访的情况下就诊的RA患者的预期队列。初步分析将使用多元回归来比较两组在一年内疾病活动评分的变化，同时考虑可能影响远程医疗VTC随访的患者、社区、疾病相关、卫生系统和卫生信息技术因素的潜在混淆。该项目将评估已经在阿拉斯加部落卫生系统实施的干预措施，但有可能推广到其他有地理或其他障碍的人群去看风湿病医生。

 DESCRIPTION (provided by applicant): Rheumatoid arthritis (RA) is a chronic autoimmune disease predominantly affecting joints, leading to high rates of disability and increased mortality American Indian/Alaska Native (AI/AN) populations have a high burden of RA. The guidelines for treatment of RA require frequent visits to a rheumatologist. In the United States, there is a shortage of rheumatologists which disproportionately affects minority and rural populations. Alaska has been a leader in telemedicine innovation, more recently with dramatically improved video teleconference (VTC) capability in multiple rural clinics. This VTC technology is expected to improve access to care for rural patients and to improve quality of care, given that quality of care for RA depends on access to rheumatologists. Although the uptake of telemedicine is increasing in many specialties worldwide, there are limited data on clinical outcomes associated with implementation of telemedicine VTC follow-up. The objective of this proposal is to evaluate the impact of telemedicine rheumatology VTC follow-up on outcome and process measures of quality of care for RA. The central hypothesis is that telemedicine will be associated with improved quality of care. The hypothesis will be tested with the following specific aims: Specific Aim 1) Determine the impact of telemedicine on disease activity, a patient-centered outcome measure of quality of care for RA; and Specific Aim 2) Investigate the impact of telemedicine on process measures of quality of care for RA. The research design is enrollment of a prospective cohort of RA patients seen by a rheumatologist with or without telemedicine VTC follow-up. The primary analysis will use multiple regression to compare change in disease activity score over one year across the two groups, while accounting for potential confounding by patient, community, disease-related, and health system and health information technology factors that might influence use of telemedicine VTC follow-up. This project will evaluate an intervention that has been implemented in the Alaska Tribal Health System, but has the potential for generalizability to other populations with geographic or other barriers to access to rheumatologists.