The complexity of care for patients with rheumatoid arthritis: metrics for better understanding chronic disease care

Med Care. 2007 Jan;45(1):55-65. doi: 10.1097/01.mlr.0000237425.58554.66.


Background: Patients with rheumatoid arthritis (RA) provide an important opportunity for understanding care of patients with a serious chronic condition.

Objectives: We sought to characterize the complexity of care for patients with RA, including metrics describing the patient, the disease, and use of the health care system across time and place.

Methods: We undertook a prospective cohort study of 568 community-dwelling patients with RA by using observational data from clinically detailed telephone interviews at baseline and 2 years later in addition to medical record abstraction. Health status, comorbidity, use of disease-modifying antirheumatic drugs, visits, providers, provider types, encounter settings, and the discontinuity between patients and providers were studied.

Results: Within a 12-month window, 568 patients had 8686 outpatient encounters with the health care system with a mean of 3.41 unique providers per patient associated with a mean of 5 primary care and 6 rheumatologist visits. Half did not see a primary care physician, and 20% did not see a rheumatologist during 6-month periods despite their use of potentially toxic drugs, a mean of 4 comorbidities and progressive RA. Over the course of 24 months, 29% of patients changed their primary care provider, and 15% changed their rheumatologist. Patients were moderately impaired with mean SF-12 physical component score 37 (SD, 9).

Conclusion: Patients with RA have frequent encounters with multiple providers and also frequent discontinuity of care. Recognizing the complexity of the care of patients with a chronic disease across multiple dimensions provides an opportunity to better understand challenges and opportunities in delivering high quality care.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Arthritis, Rheumatoid / classification
  • Arthritis, Rheumatoid / diagnosis
  • Arthritis, Rheumatoid / therapy*
  • Cohort Studies
  • Comorbidity
  • Female
  • Humans
  • Male
  • Medical Records
  • Medicine / statistics & numerical data
  • Middle Aged
  • Personal Health Services / statistics & numerical data*
  • Quality of Health Care / statistics & numerical data*
  • Severity of Illness Index
  • Specialization