Rheumatology Rapid Access Clinic: An Accelerated Access Model of Care
Notice bibliographique
Résumé
Objectives The Canadian healthcare system is well-regarded for its dedication to provide equitable care to all residents. Despite this commitment, concerns about wait times and access to care prevail, especially for patients transitioning from primary to specialized care.[1] In particular, wait times for rheumatology consultation can be lengthy.[2] In Ontario, the average wait time for assessment of suspected inflammatory arthritis is 74 days, far exceeding the benchmark target of 4 weeks.[3] Key drivers of longer wait times include the incongruity between rheumatology workforce supply and demand, which is further exacerbated by the increasing volume of patients. The lack of access to timely rheumatology consultation is predicted to worsen in the coming years2. To address this gap in access, a Rheumatology Rapid Access Clinic (RAC) led by an Advanced Clinic Practitioner in Arthritis Care (ACPAC) trained extended role practitioner (ERP) was established at Mount Sinai Hospital (MSH). A quality improvement project was undertaken to assess the impact of the RAC on timely access to care, reduction of emergency department readmissions, and the identification of diagnostic frequencies and subsequent absorption into the hospital’s Rheumatology Division. Methods Patients presenting to the MSH Emergency Department (ED) or Family Health Team (FHT), with suspected or confirmed rheumatologic conditions, as diagnosed by the attending practitioners/physicians, were referred to the RAC based on clinical need for expedited care. An ERP conducts a comprehensive assessment, including referring for appropriate laboratory tests and imaging per established medical directives. Thereafter, a treatment plan is initiated in collaboration with the attending rheumatologist. Results During the 10-month project period (September 2023 to July 2024), the RAC assessed a total of 96 patients. Of those referred, 94.1% attended their appointments. The majority of patients were female (59.4%). The average patient age was 50.0 years. The average time from referral to the initial appointment was 9.6 working days. Approximately 9.3% of the patients returned to the MSH ED with 3 patients re-referred from the RAC for medical concerns. Gout was the most frequently assessed condition, accounting for 18% of cases. 56% of the patients were integrated into the rheumatologists’ practice for ongoing care. Conclusion A Rheumatology RAC led by an ACPAC trained ERP facilitated timely and effective assessment and treatment planning for patients referred from primary or emergent care. This approach has the potential to optimize outcomes and could serve as a model for similar settings facing challenges with access to care. [1.] Bonello JP. University of Toronto Medical Journal 2023;100:29-3. [2.] Kwok TS. Clinical Rheumatology 2023;42(4):1205-1. [3.] Widdifield J. CMAJ Open 2016;4:E205-12.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,005 | 0,002 |
| Science ouverte | 0,005 | 0,007 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,018 | 0,003 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».