Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Rheumatology Practice Profiles in Teaching and Community Settings: Implications to Fellowship Training
Negron, Amarie M., Diaz-Correa, Leyda M., Mayor, Angel M., Vila, Salvador, Vila, Luis M.
Specialty and subspecialty medical training programs must provide trainees a wide and balanced exposure to clinical entities. Although university-based programs usually allow residents to learn the evaluation and management of unusual and difficult cases, they do not always provide the required experience to manage common and less complicated medical conditions which are usually seen at community-based medical facilities. Few studies have addressed these concerns. The aim of this study was to compare the rheumatology practice profiles of a university setting and two community-based rheumatology practices.
Claim forms submitted from rheumatology practices to healthcare insurance companies in 2007 were evaluated. The university and community settings were located in the same geographic region of a United States city. The university setting has an accredited Rheumatology Training Program by the Accreditation Council for Graduate Medical Education and fellows had clinical exposure to all rheumatology services provided by the institution. Demographic parameters, primary diagnoses (per International Classification of Diseases, Ninth Revision), type of patient visit and rheumatologic procedures (per Current Procedural Terminology-4) were examined. Variables were analyzed by chi-square and Student's t tests.
A total of 8,153 claim forms were evaluated; 1,893 from the university setting and 6,260 from the community practices. The demographic features, type of patient visit, rheumatologic procedures and primary diagnoses are shown in the table below.
|Feature||University (n = 1,893)||Community (n = 6,260)||p value|
|Age, mean years (SD)||45.4 (15.3)||55.7 (16.2)||<0.001|
|Gender, % women||88.3||88.5||0.002|
|Office visit, %||89.9||99.7||<0.001|
|Emergency room visits, %||0.5||0.0||<0.001|
|Hospital visits, %||9.2||0.2||<0.001|
|Joint injections, %||3.0||10.4||<0.001|
|Soft tissue injections, %||1.7||5.3||<0.001|
|Rheumatoid arthritis, %||17.2||11.4||<0.001|
|Systemic lupus erythematosus, %||39.6||14.0||<0.001|
|Sjögren's syndrome, %||0.4||2.2||<0.001|
|Inflammatory muscle disease, %||2.4||0.4||<0.001|
|Polymyalgia rheumatica, %||0.3||1.2||<0.001|
|Unspecified connective tissue disease, %||3.0||8.1||<0.001|
|Vasculitic syndromes, %||2.6||0.8||<0.001|
|Fibromyalgia syndrome, %||2.0||7.0||<0.001|
|Regional rheumatic pain disorders, %||1.5||8.0||<0.001|
|Low back pain, %||0.4||5.8||<0.001|
Several differences were found in the rheumatology practice profile among patients seen at the university and community settings. This study suggests that efforts should be undertaken to provide a more rounded and diversified patients' exposure to rheumatology fellows at this institution.
To cite this abstract, please use the following information:
Negron, Amarie M., Diaz-Correa, Leyda M., Mayor, Angel M., Vila, Salvador, Vila, Luis M.; Rheumatology Practice Profiles in Teaching and Community Settings: Implications to Fellowship Training [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1363