Dr. Troy Randall with cytometry equipment.

Associate Professor Maria Danila, MD, MSc, MSPH has received an Innovative Research Award from the Rheumatology Research Foundation. She will investigate how increased tele-rheumatology due to COVID-19 impacts the health outcomes of patients with rheumatic and musculoskeletal diseases.

Patient Relevance

The COVID-19 crisis has engulfed the U.S. leading to a dramatic uptake in remotely-delivered care in many specialties, especially in non-procedural areas like rheumatology. Rheumatic and musculoskeletal diseases are one of the most common reasons to seek outpatient care. Patients living with rheumatic and musculoskeletal diseases are distinctly at risk for COVID-19 due to multimorbidity burden.

The standard of care for many rheumatic and musculoskeletal diseases, such as rheumatoid arthritis and lupus, is to use immunosuppressive drugs such as glucocorticoids and biologics. These agents increase the risk for infections and require close monitoring for side effects. Given that some rheumatic and musculoskeletal disease drugs like tocilizumab are currently being used in COVID-19 treatment, intermittent drug shortages resulting from this expanded use may put patients at risk for flares. Little is known about whether higher risk and socially vulnerable groups of people with rheumatic and musculoskeletal diseases have a greater burden of inadequate healthcare during COVID-19 era.

While tele-rheumatology has an important role to play for delivering healthcare in this population, there is a clear knowledge gap about the comparative effectiveness of tele-rheumatology versus in-person visits, especially in patients using immunosuppressive drugs. Additional data is needed to assess the capacity of tele-rheumatology to facilitate shared decision-making and best possible outcomes. Thus, it is critical to rapidly and rigorously assess patients’ acceptance, barriers, and satisfaction with tele-rheumatology. It is also vital to examine the processes of care and downstream health outcomes stemming from tele-rheumatology, so that patients, clinicians, and policy makers adequately plan now and in the future.

To this end, we will pursue these specific aims:

  1. Compare tele-rheumatology to usual care for patient experience and downstream health outcomes including patient reported outcomes (self-efficacy), processes of care (monitoring for medication safety, immunosuppressive medication refill adherence), and healthcare services utilization (emergency department visits for infections or flares incompletely assessed with tele-rheumatology); and

  2. Determine the influence of social determinants of health on patient experience and downstream health outcomes in patients with rheumatic and musculoskeletal diseases who are managed by tele-rheumatology versus usual care.

Effective strategies to care for medically and socially vulnerable patients must address the known and evolving obstacles across the continuum of care identified by the American College of Rheumatology in its Task Force Report on Telehealth. 

The study will have far reaching impact by informing healthcare delivery and will lead to paradigm shifts in the care of patients with rheumatic and musculoskeletal diseases during and beyond the COVID-19 era.