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.
This project addresses an important gap in care, access to rheumatologists for treatment of rheumatoid arthritis. By evaluating the impact of telemedicine on the quality of care, it has the potential to improve outcomes for many patients with rheumatoid arthritis in rural areas or who otherwise have barriers to accessing care. It also fillsa gap in the literature on telemedicine, as few studies have evaluated the impact of telemedicine on patient-centered outcomes.
