title: Improving patient flow of people with rheumatoid arthritis has the potential to simultaneously improve health outcomes and reduce direct costs.
abstract: In our current economic climate of scarce resources there is a lot of debate around the best - and most efficient - way of delivering care, which points patients towards the right physician at the earliest opportunity. The aim of the study was to assess whether an improvement in the interdisciplinary management of rheumatoid arthritis (RA) has the potential to simultaneously improve health outcomes and reduce costs.
  
  
  
  In a first step, we modelled the ways which lead patients with RA to the correct diagnosis, and the relevant specialist, respectively. On average, a patient experiences 3 GP visits before referral to a specialist. We compared this situation against a reconfiguration of current practice towards a more proactive identification and referral method with initiation of care by a rheumatologist early in the disease. We evaluated the impact of this reconfiguration on the number of RA patients diagnosed and the costs associated with the diagnostic process.
  
  
  
  Using data on epidemiology and Austrian practice patterns, we estimate a total of 5294 people with undifferentiated arthritis per year, of which 1765 suffer from RA. Modelling for diagnostic accuracy, we found that 1200 of these patients are initially misdiagnosed in a primary care setting and 95 at a rheumatologist. Our model found that a reconfiguration of current practice towards an approach of more integrated care has the potential to be not only cost-effective, but cost-saving: EUR 100,188 could be saved annually by exclusively adopting the new approach.
  
  
  
  Our results show that by better directing the flow of people with RA, simultaneous clinical and economic benefits may be reaped:.
authors.affiliation: Rheumatologist in Private Practice, Wels, Austria. rudolf.puchner@cc-net.at.
authors.forename: R
authors.initials: R
authors.lastname: Puchner
authors.affiliation: Institute for Statistics and Mathematics, Vienna University of Economics and Business Administration, Vienna, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Hochreiter
authors.affiliation: 2nd Department of Medicine, General Hospital Linz and Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Pieringer
authors.affiliation: Academy for Value in Health, Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Vavrovsky
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D001317:Austria / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000592:standards; D011320:Primary Health Care / Q000191:economics* / Q000592:standards; D012017:Referral and Consultation / Q000191:economics* / Q000592:standards; D000072140:Rheumatologists / Q000191:economics / Q000592:standards
keywords: Cost of illness; Delivery of care; Health care research; Rheumatoid arthritis