title: A proposed approach to recognise "near-remission" quantitatively without formal joint counts or laboratory tests: a patient self-report questionnaire routine assessment of patient index data (RAPID) score as a guide to a "continuous quality improvement" s.
abstract: A proposed approach is presented to recognise a status of "near-remission" in a patient with rheumatoid arthritis (RA) on the basis of patient self-report questionnaire data without formal joint counts or laboratory tests. Indices of patient-reported outcome (PRO) measures distinguish active from control treatments in RA clinical trials at levels similar to American College of Rheumatology (ACR) or disease activity score (DAS) 28 improvement levels. PRO measures on a multidimensional health assessment questionnaire (MDHAQ) can be compiled into a routine assessment of patient index data (RAPID) score. RAPID 3 includes the three PRO measures from the ACR Core Data Set - physical function, pain, and global estimate. RAPID 4 adds a self-report joint count from a rheumatoid arthritis disease activity index (RADAI). RAPID 5 adds a physician estimate of global status. RAPID cores may be classified into four preliminary proposed categories, as "near-remission" (0-1), "low severity" (1.01-2), "moderate severity" (2.01-4), and "high severity" (> 4), analogous to the four categories of the DAS28 of "remission" (< 2.6), as well as "low" (2.6-3.19), "moderate" (3.2-5.1), and "high" (> 5.1) disease activity. RAPID scores are correlated significantly with DAS28 (rho = 0.64-0.67, p < 0.001), and about 75% of patients with DAS < 2.6 have RAPID scores < 2, while about 75% of patients with DAS > 5.1 have RAPID scores > 4. RAPID data are available on one side of one page, and are feasible to collect in standard clinical care. RAPID 3 scores may be calculated in about 10 seconds, and RAPID 4 and RAPID 5 scores in 20 to 30 seconds. RAPID scores every 3 months or more on simple flowsheets can be a basis for a "continuous quality improvement" strategy in standard clinical care to recognise a need for aggressive therapy, an inadequate response to a therapy, and "near- remission" status.
authors.affiliation: Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-4500, USA. t.pincus@vanderbilt.edu
authors.forename: T
authors.initials: T
authors.lastname: Pincus
authors.forename: Y
authors.initials: Y
authors.lastname: Yazici
authors.forename: M
authors.initials: M
authors.lastname: Bergman
authors.forename: C
authors.initials: C
authors.lastname: Swearingen
authors.forename: T
authors.initials: T
authors.lastname: Harrington
mesh_terms: D000203:Activities of Daily Living; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000628:therapy; D006801:Humans; D010147:Pain Measurement; D010358:Patient Participation; D017060:Patient Satisfaction; D011787:Quality of Health Care; D020127:Recovery of Function; D012074:Remission Induction; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D017749:Total Quality Management