Background/Purpose: Population
management (PM) offers a promising approach to providing Treat-to-Target (T2T) care
for rheumatoid arthritis (RA). PM depends on providing standardized, on-time disease
activity (DA) assessments and coordinated care across the entire disease
population, as well as for individual patients within this context. This study
investigates the adoption of PM registries in rheumatology practices, the use
of standardized DA measures (referred to as signal
measures) as chosen by participating rheumatologists, and the barriers some
practices are encountering as they strive to implement PM.

Methods: The
Rheumatoid Arthritis Practice Performance (RAPP) Project is a voluntary collaboration
of U.S. clinician rheumatologists (current N = 168) who manage more than 80,000
RA patients in total. Participating physicians are enrolling their RA patients
(ICD-9 code 714.0) into a HIPAA-compliant disease population registry from
practice billing records or during clinical visits. They are then collecting
signal measures and current medications on these patients over time. With
isolated exceptions, their preferred signal measures include one or more of the
following: RAPID3, a 0-10 Provider Global Assessment (PGA), Clinical Disease
Activity Index (CDAI), and a multi-biomarker (MB) test. The registry enables
real-time Population Reports that track assessment timeliness (consistent with
T2T recommendations) and monitor the DA distribution within each physician’s
enrolled RA population. Lists of overdue patients are also generated from the
registry. The RAPP Project’s coordinators regularly assess physicians’ progress
toward PM and the barriers they encounter.

Results: To this
point, 86 RAPP Project physicians have fully enrolled their RA population in a
population registry. Signal measure results reported by these physicians
include:

Despite strong intentions, many practices encounter barriers
to implementing a population registry and PM workflows, including: 1) temporary
practice or personal crises, such as partners leaving or illnesses; 2)
physicians and staff lacking the time, resources, and skills to implement the
necessary practice changes; and 3) administrative objections, especially in larger
group practices.

Conclusion: 1. Increasing
numbers of physicians and staff have been able to implement a simple yet robust
population registry in their busy practice environments. 2. They are collecting one or more signal
measures across their population. 3. They are using their registry data to
create PM workflows and improve “on-time” DA assessment. 4. Both practice-based
and health system barriers present challenges to implementing PM in many
practices.