Background Early stages of rheumatic diseases are still difficult to diagnose and treatment is delayed often due to the lack of practicing rheumatologists. Therefore, novel ways of diagnostic strategies are urgently needed. Objectives Evaluation of a structured screening system for selecting and treating patients (pts) with rheumatoid arthritis (RA) or rheumatic and musculoskeletal diseases (RMD) with health professional assistants (HPA, trained specialist nurses). Methods 177 pts visited a screening appointment for early arthritis (EA) between February 2015 and July 2016 in a specialised EA clinic. Inclusion criterion was arthritis in ≥one joint for less than one year. Pts had three options for accessing the screening: phone call with qualified HPAs, online questionnaire or attending a walk in clinic (figure 1). Upon screening, all pts filled in a digital questionnaire about their symptoms and comorbidities. In group 1 an HPA performed the joint count and analysed the questionnaire for 116 pts before giving a suspected diagnosis. Subsequently, a rheumatologist saw these pts and also made a suspected diagnosis. 61 pts in group 2 were examined directly by a rheumatologist. In case of a suspected RMD or abnormal laboratory parameters, pts received a new appointment for completing diagnostics, or in acute cases, treatment was started immediately. All pts had the opportunity of a new appointment in case of persistency or worsening of the symptoms. Results Pts had a mean age of 50.9±15.2 years and 135 (76.3%) pts were female. 160 (90.4%) pts had access to the screening by phone call. 10 (5.7%) pts used the online questionnaire, and 7 (3.9%) pts used the walk-in consultation. Pts waited 3.1±1.8 weeks for a screening appointment. According to the digital questionnaire pts had symptoms for 58.1±90.5 weeks at the screening appointment. 34 (56.7%) pts with RMD visited the screening clinic within six months after symptom onset. 2 (1.7%) pts had an RMD that had not been suspected by the HPA upon screening in group 1 and subsequently received conventional disease modifying antirheumatic drugs (cDMARDs) and glucocorticoids (GC). In group 2, 3 (4.9%) pts received cDMARDs although in the screening an RMD had not been initially suspected by the rheumatologist. In total 69 (39.0%) pts finally had an RMD, whereof 43 (24.3%) pts had an RA. 44 (24.9%) pts received therapy with a cDMARDs and 6 (3.4%) had the recommendation for a therapy with cDMARDs but refused treatment. Therapy with cDMARDs started 44.8±41.9 days after screening. 21 (11.9%) pts could already start with GC at the screening appointment. 27 (15.2%) pts without a diagnosed RMD visited the rheumatologist at least twice. Conclusions HPAs can select pts with RMDs efficiently in a structured screening system which leads to treating RMDs at an early stage in times of limited resources. Acknowledgements Abbvie supported the project within the T2T Initiative Germany. Disclosure of Interest None declared

Background Early stages of rheumatic diseases (0–12 weeks) including rheumatoid arthritis (RA) are still difficult to diagnose. For this reason, incorrect referrals to a rheumatologist result in a high use of resources in outpatient clinics. Objectives Implementation of a structured screening system for selecting and treating patients (pts) with RA or other rheumatic and musculoskeletal diseases (RMD). Methods 98 pts visited a screening appointment for early arthritis (EA) between February 2015 and September 2015 in special EA departments. Inclusion criterion was arthritis ≥ one joint for less than one year recorded by phone. Qualified health professional assistants (HPA) conducted the phone call. Upon screening, all pts filled in a tablet based questionnaire to be developed for future online use about their symptoms. Subsequently, 53 pts (group 1) were seen first by an HPA who analysed the questionnaire and performed the joint count. Based on these findings, the HPA made a suspected diagnosis. Afterwards, also a rheumatologist saw these pts and made a suspected diagnosis. In comparison, the rheumatologist directly examined 45 pts without an HPA (group 2). In both groups, typical clinical findings led to a new appointment, or in acute cases, treatment was started immediately. If an RMD was suspected or laboratory parameters were abnormal, pts received a second appointment as well. The documentation of the real-life data was carried out by the Medpath© system based on medical and flexible adaptable paths. Results Mean duration between phone call and screening was 19.6±12.8 days. Pts had an age of 18–80 years (mean 51.1±15.5 years), and 73 pts (74.5%) were female. Although all pts had reported symptoms of less than one year over the phone, only 70 pts (71.4%) fulfilled this criterion when asked in the questionnaire. In group 1, according to the HPA 22 of 53 (41.5%) pts had an RMD upon screening. The suspected diagnoses of HPA and rheumatologist corresponded in 43 of 53 (81.1%) pts in the screening. In group 2, the rheumatologist suspected 14 of 45 (31.1%) pts having an RMD in the first visit. 59 (60.2%) pts had no RMD. 23 (23.5%) pts had RA that was seropositive in 14 (14.3%) pts. All RA pts were recommended a therapy with conventional disease modifying antirheumatic drugs (cDMARDs) and glucocorticoids (GC), which 21 (21.4%) pts started 17.2±27.6 days after screening. 3 (3%) pts initially had a preclinical seropositive RA, which changed into definite RA in need for treatment with cDMARDs after 191 days in one patient. 3 (3%) pts received inpatient treatment and systemic lupus erythematosus was diagnosed in one case. Conclusions The structured screening system efficiently selects pts with RMDs and leads to treating RMD at an early stage in times of limited resources. Acknowledgement Abbvie supports the project within the T2T Initiative Germany. Disclosure of Interest None declared

Das Tätigkeitsprofil der Universitätskliniken umfasst die Ausbildung vom medizinischen Nachwuchs, die Forschung, die Einführung medizinischer Innovationen, aber auch in einem großen Umfang die Patientenversorgung. Die inzwischen unverzichtbaren Versorgungsangebote werden stationär, teilstationär und ambulant bereitgestellt. Neben ihrer primären Rolle in der Behandlung von seltenen Erkrankungen und schwierigen Fällen unterstützen sie zunehmend die allgemeine Patientenversorgung. So stehen ambulant zahlreiche verschiedene Zugangs- und Behandlungsmöglichkeiten bereit. Die Finanzierung von Universitätsambulanzen und -kliniken basiert auf der Hochschulfinanzierung, Drittmitteleinnahmen aus der Forschung, Einnahmen aus der Krankenversorgung und Fördermitteln des Landes für Investitionen. In den letzten Jahren zeichnen sich jedoch vermehrt wirtschaftliche Verluste, Investitionsstaus und mangelnde Finanzierungen ab, womit eine Hochleistungsmedizin nicht ausreichend sichergestellt werden kann. Die Professoren entwickeln sich dabei zu Wissenschaftsmanagern, die nach ihrem wirtschaftlichen Outcome und ihrer Wettbewerbsfähigkeit beurteilt werden. Zugleich sind sie in die großen universitären Strukturen eingebettet und können daher im Vergleich zu niedergelassenen Ärzten Entscheidungen selten eigenständig treffen. Prozesse, notwendige Investitionen und Restrukturierungen verzögern sich oft erheblich. Strategien zur langfristigen Finanzierung und Sicherstellung der Universitätskliniken und -ambulanzen müssen erarbeitet werden.

The working profile of university hospitals includes medical education, research and implementation of medical innovations as well as large volume patient care. University hospitals offer inpatient, day care and outpatient care which are of essential value for many patients. Besides their primary role in treating rare and orphan diseases and complex cases, they increasingly support general patient care. There are different kinds of outpatient access and treatment options available. The funding of university hospitals and clinics is based on general university funding, income from third party funds for research, income from patient care and funding from the federal states for investments. In recent years these institutions have suffered more and more from economic deficits, a lack of investment and inadequate funding whereby high performance medicine cannot be sufficiently supported. Professors are developing into scientific managers and are frequently assessed by economic outcome and competitiveness. At the same time they are embedded in the structures of the university and are not in the position to make decisions on their own, in contrast to doctors in private practices. Therefore, processes, necessary investments and restructuring are significantly delayed. There is a need to develop strategies for long-term funding and providing university hospitals and clinics with the means to deliver the necessary services.