The study: Reed G, Deeb M, Mathew J, et al. Pregnancy outcomes from a multidisciplinary obstetric-medicine/rheumatology clinic in the United States: A five-year retrospective analysis. Arthritis Care Res (Hoboken). 2024 Dec;76(12):1744–1750.
Coordinated Ophthalmic & Rheumatologic Care
Measurable outcomes of a coordinated care clinic
By Catherine Lavallee, MD, & Melissa Lerman, MD, PhD, MSCE
Why was this study done? Non-infectious uveitis often requires treatment with systemic immunosuppression. For expertise with these drugs, ophthalmologists frequently rely on rheumatologists to co-manage care. Coordinated clinics have been recommended to decrease barriers to communication and visit burden that arise when being cared for by two specialists. Yet there is a knowledge gap in the literature as to whether coordinated clinics provide improved care over that provided to patients who see both physicians separately.
What were the study methods? The study examined patients with anterior uveitis cared for by rheumatologists at a single institution, Children’s Hospital of Philadelphia, between 2013 and 2022. The study compared outcomes between patients who primarily received treatment in either a coordinated care or a traditional care arrangement. Survival analyses explored differences in cohort disease activity and biologic disease-modifying anti-rheumatic drug (DMARD) use. Steroid use, disease complication and absolute number of visits were compared.
What were the key findings? The traditional care cohort included 170 patients, and the combined care cohort included 45 patients. The median time until disease control differed (combined vs. traditional, 77 vs. 136 days, respectively, P<0.01). The median time until biologic initiation for the traditional cohort was 662 days and 98 days for the coordinated care cohort (P<0.01). The rate of topical corticosteroid use per appointment was 96% lower for the combined care cohort within the first year. Rates of total visits were 67% lower for patients receiving coordinated care, when controlling for the patients’ total complications.
What were the main conclusions? In this study, we demonstrate that coordinated care improved important uveitis outcomes, including reduced time to disease control, minimized corticosteroid use and accelerated initiation of biologic DMARDs in our single-center cohort.
What are the implications for patients & clinicians? Coordinated care clinics can provide better care—improved outcomes and fewer total appointments. Improved outcomes may have been positively impacted by increased expertise of clinicians in the coordinated clinic and the extent to which these physicians also provide traditional care at Children’s Hospital of Philadelphia. In future work from this population, we will assess visual outcomes, best corrected visual acuity and glaucoma.
