Proposed work develops content and tests the feasibility of CarePrep, a Web-based patient self-assessment instrument, in patients with rheumatoid arthritis (RA). RA is a common disorder that usually causes rapid loss of function, but early, aggressive treatment improves outcomes. Instruments that measure health-related quality of life (HRQL) are useful to assess treatment in RA populations, and probably are useful in monitoring and adapting therapy in individual patients. Whereas paper HRQL instruments are difficult to use, Web-based instruments provide an attractive approach. The CarePrep interview has already been built for general medical and gastroenterological assessment. CarePrep uses a modular design wherein every element can be configured. Configuration profiles can be crafted for a variety of clinical or research tasks; profiles are selected at appointment time.
Aims : 1) The well-established instruments for HRQL, the arthritis-specific Health Assessment Questionnaire (HAQ) and the generic RAND-36 (or Short Form 36) will installed into CarePrep. A streamlined HRQL tool (CPQL) with screening questions and configured branching will also be developed. The existing CarePrep review of systems (ROS) will be adapted to characterize symptoms, identifying extraarticular sites of disease activity and detecting potential drug toxicity. A graphic will gather patient-derived tender joint counts, a reliable index of disease activity. A modified Delphi process will be used to structure critique by experts. The CarePrep output is prioritized, problem-oriented report designed for efficient physician review; scores for joint counts and HRQL domains will be included. 2) The application will be pilot tested and focus groups held. 3) Testing 100 RA patients, accuracy of the ROS will be assessed by physician rating of CarePrep reports. The sensitivity of screening CPQL questions will be assessed by bypassing branching thresholds so that all HRQL questions will be asked. The patient's CarePrep joint count will be compared to a physician count. 4) Feasibility testing will be conducted that mimics anticipated use of CarePrep in practice settings. Patients will do the computer interview and then evaluate the experience. Practicing physicians will review the report, evaluate the patient, and then assess the utility of the report. We anticipate that CarePrep will be well accepted by patients and physicians and provide efficient monitoring of RA Status, thereby allowing more cost-effective care.
