Background/Purpose: The Arthritis Alliance developed a set of 6 performance measures to evaluate timely access to care and treatment for inflammatory arthritis. A national study is currently underway to test these measures in different data sources. The objective of this study was to examine 3 of these measures in early rheumatoid arthritis (ERA) patients receiving usual care in rheumatology clinics participating in a national longitudinal early arthritis study.

Methods: This study included ERA patients enrolled between January 1st 2007-January 31st 2015 who met 1987 or 2010 ACR/EULAR RA criteria and had < 1 year of symptom duration at cohort entry. Patients who died or moved away within 1 year of the baseline visit or who had <1 year of follow-up were excluded. Each measure was computed annually. Measures included: i) percentage of patients with RA seen in yearly follow-up (operationalized at fixed 12 and 14 month windows from the patient’s baseline visit), ii) annual percentage of RA patients treated with a disease-modifying drug (DMARD, calculated as the proportion of patients with RA with at least one record of DMARD or biologic use) and, iii) time from new RA diagnosis to initiation of DMARD therapy (defined by the time between the date of diagnosis of RA to the date of first starting a DMARD and reported as 50^th and 90^th percentile times as well as the percentage prescribed DMARDs within 2 weeks of diagnosis).

Results: 1927 RA patients were included. The mean age of the cohort was 54, with 73% female and 82% Caucasian. The average disease duration was 5.8 months and the mean DAS28 was 5.1 at baseline. Over 8 years 72% of patients were seen in yearly follow-up; when using a 14-month window this increased to 76%. The yearly percentage of newly diagnosed RA patients on a DMARD ranged between 92-100%; however, considering the whole cohort overtime the total proportion on DMARDs declined from 94% in 2007 to 70% in 2015. Between 2007 and 2015 the percentage of RA patients who received DMARD treatment within 14 days of diagnosis increased from 74% to 90%. Median time to DMARD therapy was 0 days (50^th percentile) during all years of measurement indicating treatment occurred at time of diagnosis; and the 90^th percentile decreased from 89 to 6 days between 2007 and 2015.

Conclusion: Between 2007-2015 the percentage meeting benchmarks for time to DMARD therapy increased in CATCH from 74% to 90%. A drop-off in yearly follow-up is typical of many observational studies though less in this study, perhaps due to benefits of universal access to care. This may not necessarily reflect a gap in care as patients may have returned to usual follow-up with the rheumatologist. The decline in percentage on DMARD over time likely represents a number of factors including: DMARD-free remission associated with earlier diagnosis and treatment, patient engagement and non-adherence and a possible care gap. Analysis of medication use over time is an ongoing goal of this study. This study represents a best-case scenario for capturing performance measures from systematically collected data demonstrating the feasibility of rapid DMARD initiation. Our findings may be useful as a benchmark while testing the measures using other settings and data sources.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-system-level-performance-measures-for-early-rheumatoid-arthritis-in-a-large-multicenter-cross-country-prospective-8-year-observational-cohort-study/