Background/Purpose:

The Medicare Physicians’ Quality Reporting System (PQRS) program encourages physicians to measure and report clinical processes and disease outcomes that correlate with quality care, including an Rheumtoid Arthritis (RA) measures bundle.  Physicians typically review patients’ records for a single visit to determine how many measures are documented and met, or not.  An alternative approach is to proactively collect standardized clinical data at each visit that includes that required for documenting each measure.

Methods:

The Consortium of Rheumatology Researchers of North America (CORRONA) registry collects standardized clinical data from RA patients and their rheumatologists during routine office visits, including the data for each RA measure. As examples, patients complete a modified Health Assessment Questionnaire (mHAQ)(Measure 178) and investigators complete a 0 – 10 segmented Physician Global Assessment (Measure 177). All enrolled patients have completed informed consent for the CORRONA registry.  In 2011, at least 1 visit report was submitted for 15,615 unique RA patients by 213 CORRONA investigators.   Measures evaluated included Measure 108: Disease Modifying Anti-rheumatic Drug (DMARD) Therapy is or is not prescribed, and if not, why not?; Measure 176: For patients started on a first biologic, is a TB skin test or Quantiferon assay documented during the 6 months prior to starting the treatment, or not; Measure 177: Is RA disease activity documented as controlled,-low, moderate or high; Measure 178:  Has functional status been assessed during the previous 12 months?; Measure 179:  Is RA prognosis assessed and documented as good, poor, or undetermined?; Measure 180:  Is the patient on =/> 10 mg of prednisone for greater than 6 months or not, and if so, is a management plan documented to either increase other treatments and/or taper the prednisone dose.  The most recent 2011 report for each patient was studied.

Results:

The number (N) and percent (%) of visit reports meeting or not meeting each measure are shown, as are the number of reports meeting exclusion criteria for each measure, such as patients with controlled disease off DMARD treatment being excluded for Measure 108 (N = 521), and those who were not starting a first biologic being excluded from Measure 176.

Conclusion:

Collecting standardized data assures reliable measures reporting.  The percents of Performance Met were high, except for Tb testing before DMARD initiation.