Fast-Track Clinic Reduces Hospitalization in Patients With Polymyalgia Rheumatica

The Fast-Track Clinic (FTC) significantly reduces hospitalization rates, which are historically high, in patients with polymyalgia rheumatica (PMR), according to a study published in BMC Rheumatology.¹

“The vast majority of PMR patients are diagnosed and managed in general practice,” investigators stated. “Diagnosing PMR can be challenging as many conditions can mimic the disease. The variety of symptoms may lead to hospitalization to rule out other serious diseases.”

In this retrospective, observational, cohort study, patients with PMR who fulfilled 2012 The European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) classification criteria between April 2013 and December 2018 were included in the study. It was conducted using patient data from the Department of Internal Medicine and Rheumatology at South-West Jutland Hospital in Denmark. Demographics, such as age, gender, symptom duration, inflammatory markers, pain, and imaging examinations were included. Additionally, hospitalization, inpatient days, treatment, and imaging modalities were reported. The FTC was implemented in the rheumatologic department in January 2018.

A total of 254 patients were diagnosed within the study period, 54 of which were hospitalized with a mean duration of 4.02 inpatient days. Diagnostic imaging procedures were applied for hospitalized patients to exclude underlying conditions and were much higher in this group when compared with the non-hospitalized cohort (81.5% vs 15.9%, p < 0.00001, respectively). While there were no differences in either gender or PMR symptoms, those hospitalized were more likely to present a shorter duration of symptoms (p = 0.0018) and had higher initial C-reactive protein (CRP) levels (p < 0.0001).

The FTC significantly reduced hospitalization rates from 20.4% to 3.5% (p = 0.001) as well as inpatient days from 4.15 days to 1 day (p < 0.00001). There was a significant decrease in symptom duration before diagnosis in the FTC.

Further, healthcare costs in Danish hospitals, calculated by the DRG system, for the 56 newly diagnosed patients were reduced by 65% after the introduction of the FTC when compared with the 2013 through 2017 period.

The electronic journal system used ensured collection of necessary data from this endemic region and all instances of hospitalization were captured.

However, the retrospective nature of the study was limiting. Additionally, investigators only included patients referred to the hospital, which may have excluded patients who were treated in a primary care clinic. Despite this, investigators believe it reflects the population of patients with PMR in the Danish population. Severity of symptoms, comorbidities, and disabilities were not compared between both hospitalized and non-hospitalized cohorts. Another limitation was that patients with PMR suspicion were excluded from the study as patients were identified in the database based on final diagnosis and not any tentative or referred diagnosis. Other studies that analyze FTC on patients with PMR suspicion would help answer this question.

“This is the first study to investigate the hospitalization rates and the reason for hospital admissions of newly diagnosed PMR patients. Furthermore, the implementation of an FTC approach decreases the hospitalization rates and inpatients’ days of care,” investigators concluded. “Future research should focus on PMR diagnosing challenges and how the primary sector and hospital departments can optimize their collaboration.”

Reference:

Chrysidis S, Lage-Hansen PR, Svendsen N, Diamantopoulos AP. The fast-track outpatient clinic significantly decreases hospitalisation rates among polymyalgia rheumatica patients. BMC Rheumatol. 2021;5(1):37. Published 2021 Oct 5. doi:10.1186/s41927-021-00210-6