Incorporation of patient reported outcomes data in the care of US veterans with rheumatoid arthritis

The overall goal of this proposal is to address barriers to the use of patient reported outcome (PRO) data in the Dept. of Veterans Affairs (VA) health care system. A preliminary survey of rheumatologists at the Malcom Randal VAMC confirmed that there is currently no use of PRO data. This survey identified two barriers to the use of PRO data: (1) rheumatologists were not convinced that the use of these data makes a difference in patient's outcomes, and (2) limited access to these data. Both issues are addressed in this proposal. The question addressed by this proposal is whether PRO data change patient's outcomes. The hypothesis is that the availability of these data in the form of the patient-completed MDHAQ/RAPID3 questionnaire will change patient-centric outcomes such as patient reported well-being, patient satisfaction and medication compliance. The targeted population is US veterans with rheumatoid arthritis who receive medical care within the North Florida/South Georgia Veterans Integrated Service Network (NF/SG VISN). The intervention is a single-blinded, randomized controlled trial to provide (or not provide) PRO data to the treating physicians. The second component of this study is implementation of an electronic version of the PRO that provides VA physicians with a graphical version of these data. Outcome measures used to evaluate the results of this study include a comparison between intervention and control subjects for patient-derived instruments of patient satisfaction, patient-reported disease outcome data, medication compliance, and physician/lab-derived instruments of clinical efficacy as measured by DAS28 change and DAS28 remission.