Factors that influence rheumatologists' decisions to escalate care in rheumatoid arthritis: Results from a choice-based conjoint analysis
Article first published online: 9 FEB 2010
Copyright © 2010 by the American College of Rheumatology
Arthritis Care & Research
Volume 62, Issue 6, pages 842–847, June 2010
How to Cite
Kievit, W., van Hulst, L., van Riel, P. and Fraenkel, L. (2010), Factors that influence rheumatologists' decisions to escalate care in rheumatoid arthritis: Results from a choice-based conjoint analysis. Arthritis Care Res, 62: 842–847. doi: 10.1002/acr.20123
- Issue published online: 28 MAY 2010
- Article first published online: 9 FEB 2010
- Accepted manuscript online: 9 FEB 2010 12:00AM EST
- Manuscript Accepted: 26 JAN 2010
- Manuscript Received: 16 JUL 2009
- Dutch Society for Rheumatology. Grant Number: Rheumatology grant 2008
In order to improve adherence to treatment guidelines and performance indicators advocating tight control of disease activity in rheumatoid arthritis (RA), it is important to gain insight into the factors influencing rheumatologists' decisions whether or not to escalate care. Our objective was to determine the influence of specific attributes relative to a validated measure of disease activity (the Disease Activity Score [DAS]) on rheumatologists' decisions to escalate care.
We used a computer-based choice-based conjoint analysis survey to determine the relative importance of 6 attributes on rheumatologists' decisions related to escalation of care in RA. We administered the survey in a convenience sample of rheumatologists attending the 2008 American College of Rheumatology Annual Scientific Meeting. Utilities were calculated using hierarchical Bayes modeling, and these results were used to calculate the relative importance of each attribute.
Rheumatologists assigned the most importance to the DAS score (relative importance of 30.7%) in their decision to escalate care. The age of the patient (21.5%) and erosions (20.5%) were rated as equally important in this decision. The decision to escalate care was least influenced by change in symptoms reported by the patient (11.1%), current treatment (8.9%), and disease duration (7.4%).
Our findings suggest that rheumatologists endorse the DAS as a means to guide decision making in RA. We also found that age and erosions are important influences on rheumatologists' decisions to escalate care in RA. Our results add to the literature supporting age bias in RA and suggest that further research is needed to determine how age affects quality of care in clinical practice.