RT Journal Article
SR Electronic
T1 Comprehensive Arthritis Referral Study — Phase 2: Analysis of the Comprehensive Arthritis Referral Tool
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1980
OP 1989
DO 10.3899/jrheum.140167
VO 41
IS 10
A1 Andrew E. Thompson
A1 Sara L. Haig
A1 Nicole G.H. LeRiche
A1 Gina Rohekar
A1 Sherry Rohekar
A1 Janet E. Pope
YR 2014
UL http://www.jrheum.org/content/41/10/1980.abstract
AB Objective. Rheumatologists triage referrals to assess those patients who may benefit from early intervention. We describe a referral tool and formally evaluate its sensitivity for urgent and early inflammatory arthritis (EIA) referrals. Methods. All referrals received on a standardized referral tool were reviewed by a rheumatologist and, based on the information conferred, assigned a triage grade using a previously described triage system. Each referral was also dichotomized as suspected EIA or not. After the initial rheumatologic assessment, the diagnosis was recorded and a consultation grade, blinded to referral grade, was assigned to each case. Agreement between referral and consultation grades was assessed. A regression analysis was performed to determine factors that predicted truly urgent referrals including EIA. Results. We evaluated 696 referrals. A total of 210 (30.2%) were categorized as urgent at the time of consultation. The referral tool was able to successfully detect 169 of these referrals (sensitivity 80.5%, specificity 79.4%). EIA occurred in 95 (13.6%); of those referrals, 86 were correctly classified as urgent at the time of triage (sensitivity 90.5%, specificity 69.6%). Items that helped correctly discriminate urgent or EIA referrals included patient age < 60, duration of disease, morning stiffness, patient-reported joint swelling, a personal or family history of psoriasis, urgency as rated by referring physician, prior assessment by a rheumatologist, elevated C-reactive protein, and a positive rheumatoid factor. Conclusion. A 1-page referral tool that includes parts completed by the referring physician and patient has good sensitivity to detect urgent referrals including EIA.