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Rationale
• P
rovisional diagnosis of RA by PCPs followed by referral to a rheumatologist is crucial for
optimal, evidence-based patient care:
– Reduce joint erosions, prevent lasting disabilities
– Reduce long-term medical costs (eg, joint replacements)
• T
he RAPID 2007 CME initiative focused on PCP provisional diagnosis of RA and recommended
early referral to a rheumatologist
• Availability of medical claims data
Purpose of the Pilot Study
• For physician participants in the 2007 RAPID CME initiative:
• U
sing medical claims data, determine if there was any change in the rate of office visits
to a rheumatologist for patients with a diagnosis of RA (“referral” rate) after, compared to
before, the CME activity
• Compare test group “referral” rate to that of nonparticipants (a control group)
• Measure changes in performance in CME activity participants
• Conduct a general, pilot analysis
Data Source
• A
national-scope medical claims database that represents more than 870,000 US-based
clinicians across all specialties
– CDM-Charge Detail Master (history from 2001) – providing the most detailed level of
hospital billing information for patient level drug usage, procedures, and diagnoses
in both the inpatient and the outpatient care settings from approximately 600+ hos-
pitals. Hospital data is drawn from operational files and other reference sources. The
database consists primarily of general medical-surgical hospitals but also includes
some specialty hospitals such as children’s and rehabilitation.
Support for the certified educational activities and outcomes research was provided through independent educational grants from
Abbott Laboratories, Amgen Inc. / Wyeth Pharmaceuticals, Bristol-Myers Squibb, Centocor, Inc., Genentech, Inc. and Biogen Idec, Inc.
Difference = +4.4%
50 11.8% increase in “referral” rate Pre
41.8 Post
40 37.4
“Referral” Rate (%)
30
Patients with Difference = -0.1%
Patients with
RA = 1,171 18.1 18.0
20 RA = 1,183
Visits to
Visits to Patients with Patients with
rheum = 490
10 rheum = 443 RA = 1,517 RA = 1,575
Visits to Visits to
rheum = 275 rheum = 283
0
Test Group Control Group
Matched data from 531 RAPID 2007 CME activity physician participants.