{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T10:39:17Z","timestamp":1792665557862,"version":"4.5.0"},"reference-count":50,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["480898"],"award-info":[{"award-number":["480898"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ACR Open Rheumatology"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We identified which care complexity characteristics contribute to high health care utilization (physician visits and emergency department [ED] visits) among individuals with inflammatory arthritis in Alberta.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified individuals diagnosed rheumatoid arthritis (RA), psoriatic arthritis (PsA), or axial spondyloarthritis (axSpA) between 2010 and 2015 using a validated case definition. Sociodemographic and disease characteristics contributing to care complexity were described for each population. Classification and regression tree models\u00a0were developed to identify which combination of care complexity characteristics were predictive of high health care use (physician visits and ED visits) within the first five years after diagnosis. Care complexity predictors included age, sex, place of residence, socioeconomic status (SES), inflammatory arthritis disease type, comorbidities, medication use, and opioid and glucocorticoid dispensations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Care complexity characteristics varied across cohorts (n\u00a0=\u00a013,170 individuals): older age, rural residence, multimorbidity, and glucocorticoid use were most prevalent in RA; low SES was most prevalent in PsA; and opioid use was most prevalent in axSpA. High physician visit utilization was associated with polypharmacy, the presence of anxiety, older age, living in an urban area, and having PsA (sensitivity of 78%). High ED visit utilization was associated with polypharmacy, rural place of residence, and having RA or axSpA (sensitivity of 68%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our models identified key predictors of high health care utilization in inflammatory arthritis, with modest predictive performance. These findings provide insight into factors contributing to care complexity and may support health care providers to better understand patient needs and inform resource planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr2.90134","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T06:56:30Z","timestamp":1787554590000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating Care Complexity in Inflammatory Arthritis: A Population\u2010Based Approach Using Classification and Regression Tree Analysis to Examine Health Care Utilization"],"prefix":"10.1002","volume":"8","author":[{"given":"Melissa","family":"Sipley","sequence":"first","affiliation":[{"name":"Department of Community Health Sciences Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"McCaig Institute for Bone and Joint Health Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camila","family":"Aquino","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"Department of Clinical Neurosciences Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"Hotchkiss Brain Institute Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trafford","family":"Crump","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine and Health Sciences McGill University  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3761-237X","authenticated-orcid":false,"given":"Cheryl","family":"Barnabe","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"McCaig Institute for Bone and Joint Health Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"Department of Medicine Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"Arthritis Research Canada  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glen","family":"Hazlewood","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"McCaig Institute for Bone and Joint Health Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"Department of Medicine Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"Arthritis Research Canada  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3062-5488","authenticated-orcid":false,"given":"Claire E.H.","family":"Barber","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"McCaig Institute for Bone and Joint Health Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"Department of Medicine Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"Arthritis Research Canada  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessalyn K.","family":"Holodinsky","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"Department of Clinical Neurosciences Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"Hotchkiss Brain Institute Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"Department of Emergency Medicine Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"Center for Health Informatics University of Calgary  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,23]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(23)00211-4"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22831"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2020-218282"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.2026-0088"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keaa246"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.220996"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.200420"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.4081\/jphr.2015.588"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0000000000000446"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.4852"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2024.152364"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22031"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.190659"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izac021"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203318790675"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.24095\/hpcdp.29.4.05"},{"key":"e_1_2_6_18_1","volume-title":"Material and Social Deprivation Index: A Summary","author":"Gamache P","year":"2019"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22456"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-023113"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2010.01.032"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2011.11.036"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-16399-0"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/jnu.12393"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0236370"},{"issue":"4","key":"e_1_2_6_26_1","first-page":"245","article-title":"Care complexity factors associated with revisits to an emergency department","volume":"35","author":"Urbina A","year":"2023","journal-title":"Emergencias (Madr)"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-014-0532-2"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.25541"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-024-05627-z"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.153551"},{"issue":"7","key":"e_1_2_6_31_1","first-page":"1712","article-title":"Evaluation and documentation of rheumatoid arthritis disease status in the clinic: which variables best predict change in therapy","volume":"28","author":"Wolfe F","year":"2001","journal-title":"J Rheumatol"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.091446"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare8020085"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2024.1382990"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-75888-8"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kez037"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-025-05804-8"},{"key":"e_1_2_6_38_1","unstructured":"Alberta Health.Rural Health Services Review Final Report: Understanding the Concerns and Challenges of Albertans Who Live in Rural and Remote Communities.2015."},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.210990"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.11251"},{"issue":"12","key":"e_1_2_6_41_1","first-page":"680","article-title":"The burden of psoriatic arthritis: a literature review from a global health systems perspective","volume":"35","author":"Lee S","year":"2010","journal-title":"P T"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2005.046367"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.2024-1113"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-020-01274-y"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/da.10131"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41927-019-0111-6"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2009.05.011"},{"key":"e_1_2_6_48_1","first-page":"1","article-title":"Characteristics of office\u2010based physician visits, 2018","volume":"408","author":"Ashman JJ","year":"2021","journal-title":"NCHS Data Brief"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-9-217"},{"key":"e_1_2_6_50_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.1.109-JMS0102-3-1"},{"key":"e_1_2_6_51_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-023-02070-0"}],"container-title":["ACR Open Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr2.90134","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acr2.90134","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr2.90134","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:56:19Z","timestamp":1792662979000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr2.90134"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":50,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/acr2.90134"],"URL":"https:\/\/doi.org\/10.1002\/acr2.90134","archive":["Portico"],"relation":{},"ISSN":["2578-5745","2578-5745"],"issn-type":[{"value":"2578-5745","type":"print"},{"value":"2578-5745","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-04-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e90134"}}