POS1480-HPR SCREENING WITH THE ROUTINE ASSESSMENT OF PATIENT INDEX DATA 3 QUESTIONNAIRE CAN REDUCE THE NUMBER OF CLINIC VISITS

Abstract

BackgroundThe long-term and frequent evaluation of disease activity in patients with rheumatoid arthritis (RA) leads to a large burden of planned consultations at outpatient clinics. It might be possible to reduce that burden by prescreening to identify patients with low disease activity with the electronic Routine Assessment of Patient Index Data 3 (RAPID3), with the aim to let them skip their visits. For this purpose, accurate classification of patients in the low category with the RAPID3 is required.ObjectivesTo evaluate the test characteristics and agreement between the Disease Activity Score 28 (DAS28) and the RAPID3 in patients with RA and low disease activity.MethodsWe performed a retrospective database study with clinical data collected as part of usual care from the electronic medical record at Reade Amsterdam, a secondary care center for rheumatology patients. The dataset comprised each completed RAPID3 between June 2014 and March 2021, that was followed by a DAS28 within 2 weeks in patients with RA. We dichotomized the disease activity for both the RAPID3 and DAS28 into ‘low’ and ‘high’, with cutoffs at 2.0 for RAPID3 and 3.2 for DAS28. We report test characteristics and agreement (Cohen’s kappa).ResultsThe dataset comprises 5009 combined RAPID3 and DAS28 measurements recorded in 1681 unique RA patients. Mean age was 60 years, 76% of patients were female with a median disease duration of 4 years. Overall agreement was 0,58, ƙ was fair at 0.26, with 1426 (28%) of the RAPID3 measurements in the ‘low’ category (Table 1). Sensitivity to detect low disease activity was 0.39, specificity 0.94 and positive predicted value 0.92.Table 1.Crosstabulation of dichotomised RAPID3 and DAS28* results.DAS28TotalLow (<3,2)High (>3,2)RAPID3Low (≤2,0)1309 (26%)117 (2%)1426 (28%)High (>2,1)2005 (40%)1578 (32%)3583 (72%)Total3314 (66%)1695 (34%)5009 (100%)*Disease activity score 28 (DAS28),Routine Assessment of Patient Index Data 3 (RAPID3).ConclusionWith a positive predictive value of 0.92 for low disease activity, a RAPID3 score of 2.0 or lower is a good threshold to propose a postponement of the consultation and substantially reduce the clinic burden. Such a proposal is safe if the patient can overrule it.