WASHINGTON, DC—In 2001, Dr Gail Kerr was acting as chair of VA’s field advisory committee for rheumatology and trying to decide how she could use her position to help inform VA clinical practice. She decided that to help give VA leadership the best guidance on what the field required, the committee should tap into the thoughts and needs of rheumatologists working in VA. The problem was that VA did not know who these physicians were, how many they had employed, or in which medical centers they were working. “I asked for a list of all the rheumatologists working at VA, and it did not exist,” explained Kerr in an interview with U.S. Medicine. “Central Office had no idea who these people were.”

Calls had to be placed to each medical center in VA, inquiring who on their staff saw rheumatology patients. Some were easily identified as rheumatologists, while many were under the category of internal medicine. But after much work, Kerr compiled an extensive list of every VAemployee that had a stake in what was happening in the field of rheumatology. What would become known as VA’s Rheumatology Consortium had its first meeting in 2002. “I thought my position as chair wasn’t for me to advise, but for the group to advise,” Kerr explained. “I had to find them, meet them, and hear what they thought were problems from the field.”

The Consortium has been meeting twice a year ever since. Over time, subgroups have devoted themselves to rheumatology subtopics. And the Consortium has had a significant impact on the dissemination of best practices throughout VA, and in providing informed guidance to leadership. “The goal was to have a proactive voice with widespread representation,” noted Kerr. “That has indeed happened.”

Consortium members discuss the most pressing needs of rheumatologists in VA and identify the topics that need to be highlighted for VA Central Office. Several years ago, when the risk-to-benefit ratio of the COX-2 class of anti-inflammatory drugs was still being debated, but before the FDA had made any final decision, the Consortium hosted a debate-style presentation examining the issue. “Avery active discussion occurred between these two proponents, so that the membership was informed and could interact,” Kerr explained. “And when they went back to their individual sites, they were well-armed with information on COX-2 inhibitors and making decisions on the use of these drugs.”

At a more recent meeting, Consortium members discussed perioperative management of patients with inflammatory rheumatic disease who were on biologic therapy—a topic on which there is little data. “But we had someone come in and review what data there is,” Kerr said. “We were able to have that discussion and have that information available to take back to our centers. We have become well-versed in these problematic management issues, and apply them to our patients.”

One concrete result from the Consortium’s work has been the three chronic disease registries which compile data on patients with spinal arthritis, gout, and rheumatoid arthritis. “It’s important in discussing and evaluating these [topics] that we have a point of reference,” Kerr stated. “Who else has a predominantly male elderly cohort with RA to compare with? We’re adding something to the body of literature of RAthat didn’t exist.”

Kerr stressed the fact that the Consortium does not work in a vacuum and makes sure to interact with other specialties whose interests intersect. “Our last meeting was a collaborative one with orthopedics,” Kerr said. “One of the discussions was, in a perfect world, what would it be like to have an integrated clinic of orthopedics, rheumatology, and rehab medicine?”

While topics of discussion might range far and wide, the focal point of the Consortium is always how VA can best serve its population, Kerr noted. “We are simply a group of dedicated VA rheumatologists who want to apply the best care to our patients.”

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