Background/Purpose: Timely disease activity assessment (DAA) and population management (PM) are known to reduce the burdens of chronic diseases, including RA. Currently, the measures and processes being used by clinician rheumatologists for managing RA are poorly documented. Our purpose is to survey DAA and PM processes across a cohort of clinician rheumatologists as a starting point for improving RA management and outcomes in these practices.

Methods: The Rheumatoid Arthritis Practice Performance (RAPP) Project is a voluntary collaboration of US clinician rheumatologists whose goal is to improve RA management, and to document our performance. Most invited to participate are multi-biomarker disease activity test users. To date, 97 physicians from 91 practices have attended quality improvement project kick-off meetings, and each has completed a baseline survey regarding their DAA and PM processes. Their aggregated responses are reported here.

Results: Participants represent all regions of the United States and differing practice environments: solo (33), single specialty (35), and multi-specialty group/integrated system practices (20). RA patients managed per rheumatologist derived from practice billing systems vary from 112 to 1800, self-reported patient visits/day from 12 to 80, and new patients/week from 0 to 32. Forty-six % have mid-level providers sharing in RA management, 91% have an electronic medical record (38 different brands), and 35% have any RA disease registry capability. DAAs used are highly variable, and often multiple. (Table 1) Composite DAA use varies from none (25%), to RAPID3 (39%), DAS28 (18%), CDAI (20%) and SDAI (2%). Disease activity documentation in medical records includes a non-numeric impression (active/controlled)(63%), 0-10 Physician Global (23%), composite score (11%), or other (3%).

Conclusion: 1. Practices vary in RA population size, office work flows, staffing, and DAAs utilized. 2. Use of composite disease activity measures is limited, with the majority documenting a binary, active/controlled clinical impression. 3. PM processes (analytic disease registries and team management) are used infrequently. 4. These results indicate opportunities to improve practice performance and RA disease outcomes in rheumatology practices.