Evaluation of the Impact of Telemedicine on Management of Rheumatoid Arthritis

 描述（由申请人提供）：类风湿性关节炎（RA）是一种主要影响关节的慢性自身免疫性疾病，导致高残疾率和死亡率增加，美国印第安人/阿拉斯加原住民（AI/AN）人群的RA负担很高。治疗RA的指南要求经常拜访风湿病学家。在美国，风湿病学家短缺，这不成比例地影响少数民族和农村人口。阿拉斯加一直是远程医疗创新的领导者，最近在多个农村诊所大大提高了视频电话会议（VTC）的能力。鉴于类风湿关节炎的护理质量取决于是否能获得风湿病专家的帮助，预计这种VTC技术将改善农村患者获得护理的机会，并提高护理质量。尽管远程医疗在全球许多专业中的应用正在增加，但与实施远程医疗VTC随访相关的临床结果数据有限。本提案的目的是评估远程医疗流变学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，远程医疗将与提高护理质量相关联。该假设将通过以下具体目标进行检验：具体目标1）确定远程医疗对疾病活动的影响，这是以患者为中心的RA护理质量结局指标;具体目标2）调查远程医疗对RA护理质量过程指标的影响。该研究设计是一个前瞻性队列的RA患者的风湿病学家看到或没有远程医疗VTC随访。主要分析将使用多元回归来比较两组患者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随访使用的患者、社区、疾病相关以及卫生系统和卫生信息技术因素的潜在混杂。该项目将评估已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人群的地理或其他障碍，以获得风湿病学家。

 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.