UPMC Division of Rheumatology and Clinical Immunology Expands Patient Access Through Novel Phone/Video-Based Triage Program

With a national shortage of rheumatology physicians and an increasing patient population base, health care systems and clinical rheumatology programs can struggle to manage the influx of new patient referrals while maintaining optimal access levels and wait times for appointments, assessments, and necessary follow-up care.

UPMC’s Division of Rheumatology and Clinical Immunology has experienced a significant upswing in new patient volumes in recent years, so much so that it spurred the Division and its leadership team to create a novel clinical assessment program for triaging new patient referrals and requests.

The Rapid Access Video Encounter (RAVE) program was designed as a service for initial new patient appointment requests. The RAVE program functions as a triage visit with one of the Division’s eight providers who currently cover the service on a rotating basis. The program officially began operation in August 2019 and has grown significantly in patient volume.

“Our program may be the only one of its kind in the United States designed to effectively triage new appointment requests to ensure quick access to a rheumatology specialist for those with suspected or likely rheumatologic conditions,” says Andreea Coca, MD, MPH, associate professor of Medicine in the Division of Rheumatology and Clinical Immunology, and medical director of the UPMC Lupus Center of Excellence.

Rheumatology clinicians assess patients via a secure video conference link to review their symptoms and determine if they should be seen urgently by a rheumatologist in the Division. If a patient requires further follow-up in the rheumatology clinic but can conceivably wait until the next available appointment, they are scheduled that day for a future in-person visit. If the patient should be redirected to a different specialty when the evidence is such that a rheumatologic diagnosis is unlikely, guidance is provided by the rheumatology triage clinician on the best possible course of action.

RAVE triage video encounters are 20-minute visits. Through careful questioning, observation, and review of the patient's history by one of the Division's physicians, these visits lead to placement of the patient into an appropriate management pathway for follow-up care. If a rheumatologic diagnosis is suspected, specific tests or diagnostics can be ordered before the patient's first in-person encounter to facilitate an ultimate diagnosis.

"We evaluate approximately 12 patients every day of the week through the RAVE clinic. Of that number, roughly 60 percent are referred for follow-up with a rheumatology specialist," says Dr. Coca. “For the remaining patients, our goal is not to simply dismiss them as inappropriate for rheumatology follow-up. We offer each patient our expert medical opinion, and we help connect or refer them to other specialties and providers that are likely more appropriate given our assessment. It is about getting the patient on the path toward the right care as quickly as possible, regardless of whether that care is in rheumatology or elsewhere within the UPMC system. So many times, these patients are simply grateful that their concern was taken seriously and that they had the ability to meet with a doctor who was attentive and caring and could provide the next steps to take.”

The RAVE program also allows the Division an opportunity to recommend to patients possible follow-up in one of the Division’s subspecialty clinics if the presentation of their condition warrants such a referral. For example, patients may be referred to the Lupus Center or Vasculitis Center, or one of the Division’s multidisciplinary clinics, such as the Autoimmune Interstitial Lung Disease Clinic, which may have gone unappreciated as an option by the patient or their referring medical provider. 

"We believe our RAVE program provides clear benefits in terms of reducing wait times for patients in need of rheumatologic care, while at the same time assisting individuals struggling with other concerns to find an appropriate provider," says Dr. Coca. 

Learn more about the UPMC Division of Rheumatology and Clinical Immunology and its specialty centers and institutes devoted to treating the full spectrum of rheumatologic conditions.