TEAM MANAGED OUTPATIENT CARE FOR EARLY-ONSET CHRONIC INFLAMMATORY ARTHRITIS

Objective. To determine whether an outpatient team management program for persons with early chronic inflammatory arthritis would produce im proved clinical outcomes and lower costs than traditional, nonteam out patient rheumatologic care in a clinic setting. Methods. One hundred e ighteen patients with chronic inflammatory arthritis were randomly ass igned to a team managed outpatient care program (TEAMCARE) or to tradi tional, one on one, nonteam managed rheumatologic care (TRADCARE). The TEAMCARE program consisted of a half day educational program, a needs assessment intake interview, and quarterly telephone calls, monthly t eam meetings, and routine rheumatologic care. TRADCARE patients receiv ed unconstrained, routine primary and specialty outpatient care as pra ctised typically by rheumatologists at this large multispecialty clini c. All patients had numerous physical and laboratory outcome assessmen ts by rheumatologists at office visits. Every 6 months, patients compl eted several self-report measures of functional status, pain, psychoso cial status, and costs. Results. One hundred seven patients completed one year of study participation. No significant differences were found between groups in measures of physical status, physical functioning, psychosocial status, or pain. There were no differences between groups in economic or utilization measures. Conclusion. This team managed ou tpatient program for persons with recent onset chronic inflammatory ar thritis afforded no advantage to routine outpatient care, characterize d mainly by one on one relationships between patients and primary care doctors and rheumatologists, in our active outpatient clinical enviro nment.