title: Physician ability to assess rheumatoid arthritis disease activity using an electronic medical record-based disease activity calculator.
abstract: OBJECTIVE
  To assess physicians' concordance with Disease Activity Score in 28 joints (DAS28) categories calculated by an electronic medical record (EMR)-embedded disease activity calculator, as well as attitudes toward this application.
  
  
  METHODS
  Fifteen rheumatologists used the EMR-embedded disease activity calculator to predict a rheumatoid arthritis (RA) DAS28 disease activity category at the time of each clinical encounter.
  
  
  RESULTS
  Physician-predicted DAS28 disease activity categories ranged from high (>5.1, 15% of cohort, 66 of 429 patient visits) to moderate (>3.2-5.1, 21% of cohort, 90 of 429 patient visits) to low (2.6-3.2, 29% of cohort, 123 of 429 patient visits) to remission (<2.6, 35% of cohort, 150 of 429 patient visits). Overall concordance between calculated DAS28 results and physician-predicted RA disease activity was 64%. Using either the physician-predicted or the calculated DAS28 category as the gold standard, accuracy was greatest for patients in remission (75% and 88% accuracy, respectively) and those with high disease activity (68% and 79% accuracy, respectively), and less for patients with moderate (48% and 62% accuracy, respectively) or low disease activity (62% and 31% accuracy, respectively).
  
  
  CONCLUSIONS
  Accurate physician prediction of DAS28 remission and high disease activity categories, even without immediate availability of the erythrocyte sedimentation rate or the C-reactive protein level at the time of the visit, may be used to guide quantitatively driven outpatient RA management.
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA. dscollier@partners.org
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Collier
authors.forename: Richard W
authors.initials: RW
authors.lastname: Grant
authors.forename: Greg
authors.initials: G
authors.lastname: Estey
authors.forename: Dominic
authors.initials: D
authors.lastname: Surrao
authors.forename: Henry C
authors.initials: HC
authors.lastname: Chueh
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kay