The effective alternative approach to delivery of care in rheumatology practices and health systems is to have high-risk populations identified and managed by nurse coordinators equipped with simple disease registries and care algorithms, and to have physicians and nurse practitioners involved only with those patients in need of management. This is true not only for fracture populations, but also for 65-year-old, new-to-Medicare populations. But then again, this is all there for the reading, and the RAPP Project documents the effectiveness of the same population medicine processes coordinated by nurses for managing RA populations more effectively.
A deeper question is why our academic colleagues continue to train future rheumatologists in cottage industry, physician-centric delivery-of-care methods instead of population medicine approaches utilizing care teams within which rheumatologists do what only we can do? And further, why are many current rheumatologists only slowly implementing these critical practice changes?
Timothy Harrington, MD University of Wisconsin School of Medicine and Public Health, Retired
References
- Harrington JT, Broy SB, DeRosa AM, et al. Hip Fracture patients are not treated for osteoporosis: A call to action. Arthritis Rheum. 2002 Dec 15:47(6):651–654.
- Harrington JT, Barash HL, Day S, Lease J. Redesigning the care of fragility fracture patients to improve osteoporosis management: A health care improvement project. Arthritis Rheum. 2005 Apr 15;53(2):198–204.
- Harrington JT, Deal CL. Successes and failures in improving osteoporosis care after fragility fracture: Results of a multiple site clinical improvement project. Arthritis Rheum. 2006 Oct 15;55(5):724–728.
- Harrington T. Can we deliver the promise of the bone and joint decade? US Musculoskel Review. 2006;16–17.
- Harrington JT, Lease J. Osteoporosis disease management for fragility fracture patients: New understandings based on three years experience with an osteoporosis care service. Arthritis Rheum. 2007 Dec 15;57(8):1502–1506.
- Harrington JT. A view of our future: The case for redesigning rheumatology practice. Arthritis Rheum. 2003 Oct 15;49(5):716–719.
- Harrington JT, Newman ED. Redesigning the care of rheumatic diseases at the practice and system levels. Part 1: Practice level process improvement (Redesign 101). Clin Exp Rheumatol. 2007 Nov–Dec;25(6 Suppl 47):S55–S63.
- Great Health Care: Making It Happen. JT Harrington, Newman ED (eds). New York: Springer, 2011.
- Arnold E, Arnold W, Conaway D, et al. Rheumatoid Arthritis Practice Performance Project spots problems in RA management. The Rheumatologist. 2015 Jun;9(6).
- Harrington T, Arnold E, Arnold W, et al. Help wanted: The rheumatology workforce shortage revisited. The Rheumatologist. 2016 May;10(5).
- Lakhanpal S. 2015 ACR/ARHP workforce study of rheumatology specialists predicts future workforce shortfall. The Rheumatologist. 2017 Jan;11(1).
- Gunderman R. The root of physician burnout. The Atlantic. 2012 Aug 27.
