Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Dr. Elizabeth Salt

Committee Member

Dr. Beatriz Hanaoka


The United States health care system is currently experiencing an increase in demand for services due to an aging population. Rheumatology, an Internal Medicine sub-specialty, treats those patients with arthritic conditions as well as other autoimmune and inflammatory conditions. A shortage of rheumatologists is projected by 2025, adding additional stress to an already burdened clinical area.This means patients can face substantial wait times when requesting consultation with a rheumatology provider.This capstone project will present three manuscripts that explore the referral process from primary to specialty care and strategies to reduce wait times. The first manuscript is a literature review that presents information surrounding current referral processes.The second manuscript presents current evidence-based practice guidelines on the identification and management of rheumatoid arthritis (RA) in primary care. Finally, the third manuscript evaluates a rheumatology patient prioritization triage system currently being used in a large rheumatology clinic in central Kentucky to determine its accuracy in identifying acutely ill patients. The combined information presented in these manuscripts help support recommendations for improving the referral process between primary and specialty providers to ensure that patients receive necessary care delivered in a timely manner to optimize patient experience and outcomes.

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