In team-based rheumatology care models, variations exist in team composition, collaboration, and terminology. These models often produce outcomes similar, and at times superior, to comparator care, results of a scoping review have shown.
“Advancing the field will require standardized terminology, detailed reporting of team roles and processes, and rigorous long-term cost-effectiveness evaluations to fully assess impact across all domains of the Quintuple Aim,” the researchers said.
The domains of the Quintuple Aim include population health, patient experience, costs, provider well-being, and health equity.
In this scoping review, the researchers followed the Joanna Briggs Institute methodology and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist.
The databases of Medline, Embase, Web of Science, Cochrane CENTRAL, and CINAHL were searched from inception to May 2024. Peer-review studies comparing outpatient team-based rheumatology care, involving at least one rheumatologist and one interdisciplinary healthcare provider, to other care models were included.
Finally, the researchers examined the terminology used to describe care models in relation to reported team composition and mapped outcomes to the Quintuple Aim targets.
Terminology
A total of 6,139 unique records were identified. Of these, 76 reports representing 67 studies met the eligibility criteria. [J Rheumatol 2026;53:720-738]
Team-based model often involved a rheumatologist and a nurse, but wide variations existed in a team composition. Notably, the review found inconsistency in the terminology used to describe care models and insufficient details to allow replication in care delivery descriptions.
Furthermore, several studies centred on clinical outcomes and patient experience, and only a few tackled economic, equity, or provider-related outcomes.
“Most studies focused on short-term evaluations of health outcomes and patient experience, but inconsistent terminology and lack of reporting of team composition and collaborative processes limit the interpretability and comparability of findings,” the researchers said.
“In addition, critical domains such as provider well-being, long-term cost-effectiveness, and the effect of team-based care on health equity remain insufficiently evaluated,” they added.
Standardized language
Efforts to assess, copy, and scale successful care models falter due to the lack of a standardized language. The researchers stressed the importance of clear and consistent terminology “to streamline research efforts and enable assessment of team structures, processes, and outcomes across studies/settings.”
“Existing nomenclature for collaborative care approaches has been previously described, with the terms ‘multidisciplinary’, ‘interdisciplinary’, and ‘transdisciplinary’ care positioned along a continuum that reflects increasing levels of integration in team structure and function,” they said. [Clin Invest Med 2006;29:351-364; J Multidiscip Healthc 2022;15:765-772]
However, these terms are used loosely in the literature. The researchers then recommend future studies to adopt this terminology where appropriate or use the key term ‘team-based care’ when integration level is “unclear or evolving.”
“Regardless of the terminology chosen, studies should provide detailed descriptions of team composition, roles, responsibilities, and collaborative processes (including communication, collaboration, and coordination),” the researchers said.
“Such transparency will enhance interpretability and inform implementation by clarifying operational features that underpin effective models of care,” they added.