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RAPID3 Questionnaire May Reduce Outpatient Visits in Patients With RA

Approximately a quarter of RAPID3 assessments, confirmed with 92% accuracy by DAS28 scores, reported patients had low disease activity and could, therefore, postpone routine clinical visits.

The Routine Assessment of Patient Index Data 3 (RAPID3) was shown to have 92% accuracy in identifying low disease activity in patients with rheumatoid arthritis (RA), thus reducing 28% of on-site evaluations, according to a study published in Springer.1

“Patients are chronically monitored 2–4 times a year, leading to a large number of protocolized outpatient clinic visits. However, most of these visits could probably be postponed or even omitted, as 75% of patients in routine clinical follow-up are in low disease activity or remission,” investigators explained. “Reducing the number of unnecessary outpatient clinic visits will improve access for patients in need of rapid consultation and reduce healthcare and patient costs.”

Clinical data from the electronic medical record (EMR) at Reade Amsterdam was collected in this retrospective, database study to analyze characteristics between the Disease Activity Score 28 (DAS28) and the RAPID3 questionnaire in this patient population, focusing on low disease activity categories. Between June 2014 and March 2021, RAPID3 assessments were taken and followed by a DAS28 within 2 weeks. Disease activity categories for both measures were categorized as either low (remission and low disease activity) or high (moderate and high disease activity) using a 2.0 cutoff value for RAPID3 (remission: 0 – 1.0; low 1.1 – 2.0; moderate: 2.1 – 4.0; high: > 4) and 3.2 for DAS28 (remission: < 2.6; low: 2.6–3.1; moderate 3.2–5.1; high: > 5.1).

In total, 5009 combined RAPID3 and DAS28 measurements were obtained from 1681 patients with RA. The mean age was 60 years, median disease duration was 4 years, and 76% of patients were female.

The correlation between RAPID3 and DAS28 was 0.58 for all records (p < 0.001), with comparable agreement in the 4 categories of disease state for both measures. Low disease activity was seen in 28% (n = 1426) of patients, with a 92% accuracy when compared with the DAS28 score. These patients could therefore, theoretically, skip their next outpatient visit. However, patients categorized by the RAPID3 questionnaire as having high disease activity was only confirmed by the DAS28 in 44% of cases. Sensitivity to detect low disease activity was 0.39, positive predictive value was 0.92, and specificity was 0.93.

The study was limited by its retrospective nature and the possibility of selection bias, including only evaluating results of patients with both complete questionnaires and a DAS28. Patients in this group may, therefore, have better eHealth literacy or self-management when compared with the general population. However, results are likely generalizable to patients in this region. Further, flaws in the DAS28 evaluation may have led to a misclassification of remission or low disease activity. Lastly, investigators were not able to determine if low disease activity remained over time or analyze future flares. Future longitudinal studies are needed before implementing the RAPID3 system.

“In 92% of the cases where patients score a RAPID3 of ≤ 2.0, the DAS28 is ≤ 3.2. In our routine care approximately a quarter of assessments are at or below this level and could potentially be postponed,” investigators concluded. “We propose a system where consultations are postponed when the RAPID3 is ≤ 2.0 to reduce the number of outpatient clinic visits for patients with low disease activity. Such a proposal is safe if the patient can overrule it.”

Reference:

Wiegel J, Seppen BF, Ter Wee MM, Nurmohamed MT, Boers M, Bos WH. The RAPID3 questionnaire as a screening tool to reduce the number of outpatient clinic visits: a retrospective cohort study [published online ahead of print, 2022 Apr 26]. Clin Rheumatol. 2022;10.1007/s10067-022-06162-7. doi:10.1007/s10067-022-06162-7