Physician ability to assess rheumatoid arthritis disease activity using an electronic medical record-based disease activity calculator
Department of Medicine, Division of Rheumatology
Medical Subject Headings
Arthritis, Rheumatoid; *Attitude of Health Personnel; Cohort Studies; Disability Evaluation; Disease Progression; Health Care Surveys; Health Knowledge, Attitudes, Practice; Humans; *Medical Records Systems, Computerized; Outcome Assessment (Health Care); Predictive Value of Tests; Rheumatology; *Severity of Illness Index; *Software
Musculoskeletal Diseases | Rheumatology | Skin and Connective Tissue Diseases
OBJECTIVE: To assess physicians' concordance with Disease Activity Score in 28 joints (DAS28) categories calculated by an electronic medical record (EMR)-embedded disease activity calculator, as well as attitudes toward this application.
METHODS: Fifteen rheumatologists used the EMR-embedded disease activity calculator to predict a rheumatoid arthritis (RA) DAS28 disease activity category at the time of each clinical encounter.
RESULTS: Physician-predicted DAS28 disease activity categories ranged from high ( > 5.1, 15% of cohort, 66 of 429 patient visits) to moderate ( > 3.2-5.1, 21% of cohort, 90 of 429 patient visits) to low (2.6-3.2, 29% of cohort, 123 of 429 patient visits) to remission ( < 2.6, 35% of cohort, 150 of 429 patient visits). Overall concordance between calculated DAS28 results and physician-predicted RA disease activity was 64%. Using either the physician-predicted or the calculated DAS28 category as the gold standard, accuracy was greatest for patients in remission (75% and 88% accuracy, respectively) and those with high disease activity (68% and 79% accuracy, respectively), and less for patients with moderate (48% and 62% accuracy, respectively) or low disease activity (62% and 31% accuracy, respectively).
CONCLUSION: Accurate physician prediction of DAS28 remission and high disease activity categories, even without immediate availability of the erythrocyte sedimentation rate or the C-reactive protein level at the time of the visit, may be used to guide quantitatively driven outpatient RA management.
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Citation: Arthritis Rheum. 2009 Apr 15;61(4):495-500. doi: 10.1002/art.24335. Link to article on publisher's site
Collier, Deborah S.; Grant, Richard W.; Estey, Greg; Surrao, Dominic; Chueh, Henry C.; and Kay, Jonathan, "Physician ability to assess rheumatoid arthritis disease activity using an electronic medical record-based disease activity calculator" (2009). Rheumatology Publications and Presentations. 89.