Patients with rheumatoid arthritis acquire sustainable skills for home monitoring: a prospective dual-country cohort study (ELECTOR clinical trial I)

Objective: In an eHealth setting, to investigate intra- and interrater reliability and agreement of joint assessments and Disease Activity Score using C-reactive protein (DAS28-CRP) in patients with rheumatoid arthritis (RA) and test the effect of repeated joint assessment training. Methods: Patients with DAS28-CRP ≤ 5.1 were included in a prospective cohort study (clinicaltrials.gov: NCT02317939). Intrarater reliability and agreement of patient-performed joint counts were assessed through completion of 5 joint assessments over a 2-month period. All patients received training on joint assessment at baseline; only half of the patients received repeated training. A subset of patients was included in an appraisal of interrater reliability and agreement comparing joint assessments completed by patients, healthcare professionals (HCP), and ultrasonography. Cohen’s κ coefficients and intraclass correlation coefficients (ICC) were used for quantifying of reliability of joint assessments and DAS28-CRP. Agreement was assessed using Bland-Altman plots. Results: Intrarater reliability was excellent with ICC of 0.87 (95% CI 0.83–0.90) and minimal detectable change of 1.13. ICC for interrater reliability ranged between 0.69 and 0.90 (good to excellent). Patients tended to rate DAS28-CRP slightly higher than HCP. In patients receiving repeated training, a mean difference in DAS28-CRP of –0.08 was observed (limits of agreements of –1.06 and 0.90). After 2 months, reliability between patients and HCP was similar between groups receiving single or repeated training. Conclusion: Patient-performed assessments of joints and DAS28-CRP in an eHealth home-monitoring solution were reliable and comparable with HCP. Patients can acquire the necessary skills to conduct a correct joint assessment after initial and thorough training. [clinicaltrials.gov (NCT02317939)]</p

Patients with rheumatoid arthritis acquire sustainable skills for home monitoring: a prospective dual-country cohort study (ELECTOR clinical trial I)

OBJECTIVE:In an eHealth setting, to investigate intra- and inter-rater reliability and agreement of joint assessments and disease activity score (DAS28CRP) in patients with rheumatoid arthritis (RA) and test the effect of repeated joint assessment training. METHODS:Patients with DAS28CRP ≤5.1 were included in a prospective cohort study (clinicaltrials.gov: NCT02317939). Intra-rater reliability and agreement of patient-performed joint counts were assessed through completion of five joint assessments over a two-month period. All patients received training on joint assessment at baseline, only half of the patients received repeated training. A subset of patients was included in an appraisal of inter-rater reliability and agreement comparing joint assessments completed by patients, healthcare professionals (HCPs), and ultrasonography. Cohen's Kappa coefficients and intraclass correlation coefficients (ICC) were used for quantifying of reliability of joint assessments and DAS28CRP. Agreement was assessed using Bland-Altman plots. RESULTS:Intra-rater reliability was excellent with ICC of 0.87 (95%CI: 0.83 to 0.90) and minimal detectable change of 1.13. ICCs for inter-rater reliability ranged between 0.69 and 0.90 (good to excellent). Patients tended to rate DAS28CRP slightly higher than HCPs. In patient receiving repeated training, a mean difference in DAS28CRP of -0.08 was observed (limits of agreements of -1.06 and 0.90). After 2 months, reliability between patients and HCPs was similar between groups receiving single or repeated training. CONCLUSION:Patient-performed assessments of joints and DAS28CRP in an eHealth home-monitoring solution were reliable and comparable with HCPs. Patients can acquire the necessary skills to conduct a correct joint assessment after initial and thorough training

Protocol for evaluating and implementing a pragmatic value-based healthcare management model for patients with inflammatory arthritis: a Danish population-based regional cohort and qualitative implementation study

INTRODUCTION:The provision of healthcare for patients with inflammatory arthritis occurs in the context of somewhat conflicting targets, values and drivers. Therefore, there is a need for introducing 'value-based healthcare' defined as the value of patient relevant health outcomes in relation to costs. This term is a central part of tomorrow's healthcare sector, especially for rheumatic diseases, yet the transition is a huge challenge, as it will impact the development, delivery and assessment of healthcare. AIMS:The aim of this study is to compare medical and patient evaluated impact of the traditional settlement and financing production (DAGS) controlled healthcare setting with a value-based and patient-centred adjunctive to standard care. METHODS AND ANALYSIS:Patients with inflammatory arthritis receiving treatment in routine care at the outpatient clinics in the Capital Region of Denmark will prospectively and consecutively be enrolled in a Non-Intervention-Study framework providing a pragmatic value-based management model. A Danish reference cohort, used for comparison will be collected as part of routine clinical care. The enrolment period will be from 1 June 2018 until 31December 2023. Baseline and follow-up visits will be according to routine clinical care. Registry data will be obtained directly from patients and include personal, clinical and outcomes information. The study results will be reported in accordance with the STROBE statement. ETHICS AND DISSEMINATION:The study has been notified to the Danish Data Protection Agency and granted authorisation for the period June 2018 to January 2025 (pending). Informed consent will be obtained from all patients before enrolment in the study. The study is approved by the ethics committee, Capital Region of Denmark (H-18013158). Results of the study will be disseminated through publication in international peer-reviewed journals