title: Therapeutic and diagnostic outcomes of a standardised, comprehensive care pathway for patients with systemic sclerosis.
abstract: OBJECTIVE
  To determine the outcomes, including number of medical interventions and initiation of immunosuppressive treatment of a standardised, comprehensive, diagnostic care pathway for patients with systemic sclerosis (SSc). Patient characteristics associated with need for medical interventions and with need for immunosuppressive treatment were determined.
  
  
  METHODS
  Data were routinely gathered in connection with a 2-day care pathway combining multidisciplinary care and complete diagnostic work-up of organ involvement in SSc. The number of patients in whom the pathway resulted in medical interventions, and/or initiation of immunosuppressives was recorded. Patient characteristics and diagnostic tests results were compared between patients with and without medical interventions, and patients with and without initiation of immunosuppressives by means of multivariable logistic regression analyses.
  
  
  RESULTS
  During a period of 44 months, 226 patients with SSc were referred to the care pathway. They included 186 (82%) women with mean age of 54 (SD 14.5) years, and median disease duration of 4 years (range 1-11); 73 (32%) of them had diffuse cutaneous SSc. Medical interventions were initiated in 191 (85%) patients, including initiation of immunosuppressive treatment in n=49 (22%). Presence of telangiectasias and higher erythrocyte sedimentation rate were associated with any medical intervention. Of commonly available variables, lower age, higher skin score and absence of anticentromere antibody were associated with initiation of immunosuppressives.
  
  
  CONCLUSIONS
  A standardised comprehensive 2-day care pathway for patients with SSc resulted in additional diagnostic or therapeutic interventions in 85% of the patients, regardless of SSc subtype and disease duration. In 22% of the patients, immunosuppressive treatment was initiated.
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Jessica
authors.initials: J
authors.lastname: Meijs
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Haga Hospital, The Hague, The Netherlands.
authors.forename: Anne A
authors.initials: AA
authors.lastname: Schouffoer
authors.affiliation: Department of Cardiology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Nina
authors.initials: N
authors.lastname: Ajmone Marsan
authors.affiliation: Department of Radiology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Lucia J M
authors.initials: LJ
authors.lastname: Kroft
authors.affiliation: Department of Medical Statistics , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Stijnen
authors.affiliation: Department of Pulmonology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Maarten K
authors.initials: MK
authors.lastname: Ninaber
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
authors.affiliation: Department of Orthopaedics , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Theodora P M
authors.initials: TP
authors.lastname: Vliet Vlieland
authors.affiliation: Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Jeska K
authors.initials: JK
authors.lastname: de Vries-Bouwstra
keywords: Multidisciplinary team-care; Systemic Sclerosis; Treatment