Clinical Outcomes of Patients Within the Rheumatoid Arthritis Care Pathway Cohort at a Tertiary Care Integrated Delivery Network: A Comparison to Usual Care.

Abstract

We aimed to compare clinical outcomes between patients in the Allegheny Health Network rheumatoid arthritis (RA) care pathway and patients receiving usual care. The care pathway initiative implements guideline-based best practice alongside multidisciplinary team-based care. Clinical and insurance claims data were extracted to compare the proportion of patients in clinical disease activity index (CDAI)-based remission and evaluate health care utilization and per-member per-month (PMPM) costs of care. The RA care pathway cohort included 817 patients, and the usual care cohort included 3,651 patients. The care pathway cohort had a significantly higher proportion of patients achieving remission at 6, 12, and 24 months (33.5% vs 20.3%; hazard ratio 1.53, 95% confidence interval 1.11-2.10; P = 0.008 at 24 months), and on average, remission occurred 64 days earlier than usual care. This trend was also observed when including patients with low disease activity with those in remission and in a subgroup analysis of newly diagnosed RA. RA-related PMPM costs were significantly higher in the care pathway group and primarily related to higher baseline CDAI, comorbidities, and biologic/targeted synthetic disease modifying antirheumatic drug use and switching. Patients in our RA care pathway were more likely to achieve remission than those in usual care. PMPM RA costs were higher compared to usual care. We plan to use a longer follow-up to investigate if improved clinical outcomes result in reduced direct and indirect costs, to study the impact of individual team-based care interventions, and to validate our findings in other populations.