Team-Based Outpatient Rheumatology Care: A Scoping Review of Terminology, Team Composition, and Impact on Advancing the Quintuple Aim

Abstract

Objectives Team-based models of rheumatology care, in which rheumatologists and interdisciplinary healthcare professionals (IHPs) collaborate in care delivery, are increasingly recognized to improve outcomes across all domains of the Quintuple Aim (population health, patient experience, value, provider well-being, and health equity). To systematically map existing evidence across all domains of the Quintuple Aim, we conducted a scoping review of studies evaluating outpatient team-based rheumatology care. Methods This scoping review followed Joanna Briggs Institute methodology and adhered to the PRISMA-ScR checklist. We searched MEDLINE, EMBASE, Web of Science, Cochrane CENTRAL, and CINAHL from inception to May 2024. We included peer-reviewed studies that evaluated outpatient team-based rheumatology care involving at least 1 rheumatologist and 1 IHP, compared with any other outpatient care model. Terminology describing care models was examined in relation to reported team composition, and outcomes were mapped to the Quintuple Aim targets. Results The search identified 6,139 unique records, of which 76 reports representing 67 studies met inclusion criteria. Most included studies were published within the past 15 years, indicating a recent surge in research on team-based rheumatology care (Figure 1). A wide range of team-based care models was evaluated across different rheumatic diseases and clinical contexts, ranging from smaller teams comprising a rheumatologist and 1 IHP to large, comprehensive care teams involving multiple health professionals and physicians from other specialties. Terminology used to describe care models was inconsistent, with terms (eg, multidisciplinary/interdisciplinary) often used interchangeably. In addition, most studies lacked sufficient description of the care model to enable replication. Population/patient health was the most frequently examined Quintuple Aim domain (n = 52, 78%), with outcomes largely centered on disease activity, physical function, and quality of life. Thirty-nine studies (58%) assessed patient experience outcomes (eg, satisfaction, self-efficacy). Cost outcomes were evaluated in 15 studies (22%), and provider-focused outcomes in 8 studies (12%). Equity was addressed in only 1 study, and none investigated the impact of team-based care on provider mental health or burnout. Most evaluations showed positive impacts, but were short-term, with observation periods limited to ≤12 months. Conclusion This review highlights a rapidly expanding yet heterogeneous evidence base on team-based care models in rheumatology. Most studies focused on short-term evaluations of health outcomes and patient experience, with few addressing cost-effectiveness, provider well-being, and equity. Future research should adopt standardized terminology, improve reporting of team structures and processes, and include longer-term evaluations to capture impacts across the full Quintuple Aim.