Development of an interdisciplinary early rheumatoid arthritis care pathway

Abstract

Background: To develop an interdisciplinary care pathway for early rheumatoid arthritis (RA) including referral triage, diagnosis, and management.

Methods: Our process was a four-phase approach. In Phase 1, an anonymous survey was electronically distributed to division rheumatologists. This provided data to a small interprofessional working group of rheumatology team members who drafted an initial care pathway informed by evidence-based practice in Phase 2. In Phase 3, an education day was held with approximately 40 physicians (rheumatologists and rheumatology residents), members of our interprofessional team, and two clinic managers to review the proposed care elements through presentations and small group discussions. The care pathway was revised for content and implementation considerations based on feedback received. Implementation of the care pathway and development of strategies for evaluation is ongoing across multiple practice sites (Phase 4).

Results: Our care pathway promotes an approach to patient-centered early RA care using an interdisciplinary approach. Care pathway elements include triage processes, critical diagnostics, pre-treatment screening and vaccinations, and uptake of suggested RA pharmacologic treatment using shared decision-making strategies. Pathway implementation has been facilitated by nursing protocols and evaluation includes continuous monitoring of key indicators.

Conclusion: The 'Calgary Early RA Care Pathway' emphasizes a patient-centered and interdisciplinary approach to early RA identification and treatment. Implementation and evaluation of this care pathway is ongoing to support, highest quality care for patients.

Keywords: Arthritis; Quality improvement; Quality of health care; Rheumatoid.

Fig. 1

Phases of early rheumatoid arthritis care pathway development and alignment with knowledge to action cycle (K2A) phases

Fig. 2

Choice of DMARDs for treatment of early rheumatoid arthritis. Clinical Disease Activity Index (CDAI), Disease Activity Score-28 C-Reactive Protein (DAS28-CRP), Disease Modifying Anti-Rheumatic Drugs (DMARDs), Health Assessment Questionnaire-II (HAQ-II), Patient Activity Scale-II (PAS-II)

Fig. 3

Choice of corticosteroids. Disease modifying anti-rheumatic drug (DMARD); Intraarticular (IA); Intramuscular (IM)

Fig. 4

Calgary early rheumatoid arthritis care pathway overview. Intraarticular (IA), intramuscular (IM), oral (po), disease modifying anti-rheumatic drug (DMARD)