Background/Purpose:

The CME initiative RAPID® (Rheumatoid Arthritis: Primary Care Initiative for Improved Diagnosis and Outcomes) is a 7-year series of activities that used national-scope aggregated healthcare claims data to identify primary care clinicians who diagnose and refer patients for RA at a low frequency. Medical claims data have been used since 2008 to measure the implementation of the diagnostic and referral clinical strategies resulting from the RAPID activities by analyzing performance changes of participants. Since its inception, over 65,516 physicians have completed the RAPID educational activity. We have reported statistically significant improvements in the participants’ diagnostic and referral performance (Bender S, et al. CE Measure, 2016;10:10-15).

Methods:

Rates of increased RA diagnoses and referral among providers were determined for a sample of the RAPID initiative (RAPID III) using a national-scope administrative healthcare claims database representing over 870,000 US clinicians. New RA diagnoses were defined as the number of unique patients with a diagnosis of RA (ICD-9 codes 714.X) who had a claim from both a primary care provider and a rheumatologist (shared patients) in the time period prior to, or after the CME activity date [2011] and who had been prescribed (and filled) a prescription for an appropriate RA therapy. Comparisons were made among highly matched controls of non-participants, with approximately 40 non-participant controls for every participating clinician. The follow period was approximately 2.5 years. An exploratory predictive model was used to estimate the economic impact of earlier diagnosis and treatment of RA. The model estimated how many patients with moderate/high disease activity were likely to transition to remission and the associated costs averted by decreased healthcare utilization and productivity losses. Prevention of joint arthroplasty was also predicted. Deterministic and probabilistic sensitivity analyses were performed to evaluate the influence of model parameters on the estimated outcomes of the model.

Results:

A sample of 3,919 RAPID III participants (n=1,691) was evaluated. These participants managed 265,834 patients and had 1,837 newly diagnosed patients with RA. There was a statistically significant 11% increase in the proportion of RA diagnoses by learners following participation in the CME initiative. All referred patients received appropriate therapy for RA. There was no change in the proportion of RA diagnoses among the control group. The estimated costs averted when newly diagnosed patients underwent treatment leading to remission were $11,618,483 (95% CI; $3,954,798 to $24,547,314).

Conclusion:

A CME initiative improved the post-activity performance of targeted learners significantly more than non-targeted providers. Analysis of medical claims data is a useful tool for assessing performance change in CME initiative participants. Earlier diagnosis and treatment of RA may be associated with decreased costs.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/early-diagnosis-and-treatment-of-ra-clinical-performance-and-economic-outcomes-from-a-continuing-education-initiative/