Development and evaluation of a patient self-report case-finding method for rheumatoid arthritis.
OBJECTIVE
To describe the development and evaluation of a patient self-report case-finding method for rheumatoid arthritis (RA) not dependent on direct contact with the treating physicians.


METHODS
The American College of Rheumatology criteria for RA diagnosis were adapted for patient self-report using a questionnaire, and alternative scoring algorithms were evaluated to balance case-finding sensitivity and specificity. Positive rheumatoid factor tests were used to identify 1053 individuals in 2 large healthcare organizations; 440 agreed to receive study materials. Case-finding results were validated by medical record review (MRR) for a random sample of 90 patients. Three scoring algorithms were compared with MRR for likelihood of RA diagnosis. Cases not classifiable by algorithm were flagged and reviewed by 2 expert physicians for likelihood of RA diagnosis.


RESULTS
Pilot testing demonstrated that patients comprehended the questionnaire and were willing to answer the questions. Completed questionnaires were returned by 265 (60%) of the 440 patients contacted. Following expert physician review of 16 flagged cases in the 90-patient MRR subsample, the most accurate scoring algorithm demonstrated 80% sensitivity, 67% specificity, 74% accuracy, and 77% positive predictive value for detecting early RA.


CONCLUSIONS
The case-finding method represents a promising tool for identifying RA patients, with potential application in research and quality-assurance activities.


CONCLUSIONS
This case-finding method should be useful in research and quality-assurance efforts requiring identification of RA patients treated by all types of providers in healthcare organizations in which centralized laboratory data are available.
Olive View-UCLA Medical Center, Sylmar, CA 91342, USA. alunwong@ucla.edu
Andrew L
AL
Wong
Judith O
JO
Harker
Brian S
BS
Mittman
Gerald D
GD
Levy
Ken J
KJ
Bulpitt
Keith K
KK
Colburn
Honghu
H
Liu
Katherine L
KL
Kahn
Bevra H
BH
Hahn
Harold E
HE
Paulus
Laurence Z
LZ
Rubenstein
D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D015994:Incidence; D007596:Joints; D008297:Male; D010147:Pain Measurement; D010358:Patient Participation; D010865:Pilot Projects; D016059:Range of Motion, Articular / Q000502:physiology; D015203:Reproducibility of Results; D016353:Self-Examination; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires