Session Title: Quality Measures and Quality of Care
Session Type: Abstract Submissions (ACR)
Quality assessments are being increasingly used for quality improvement, accountability, and performance based incentives. The current research regarding quality of care provided to rheumatoid arthritis (RA) patients, although limited, does identify gaps and variations in several domains of care.
The American College of Rheumatology (ACR) has endorsed seven RA quality indicators (QI), which we used to access the quality of care provided to RA patients at our institution.
A retrospective chart review was performed on patients identified by the ICD9 code for RA (714.0) entered by a Rheumatologist between 1/1/09 to 8/31/13. We excluded patients whose records were not available and those without a definitive diagnosis of RA.
Our clinic began consistently applying the Multi-Dimensional Health Assessment Questionnaire for assessment of disease activity and functional status in June 2009; therefore, we only included patients seen in our clinic between 1/1/2010 and 12/31/2012. We adhered to specifications for inclusion and exclusion criteria endorsed by the ACR regarding the seven RA QI. In addition, we excluded patients being considered for initial DMARD therapy or undergoing management for worsening disease, who were lost to follow-up. P-values were calculated using Chi-Squared Test.
A total of 356 patients were included. 87.9% (N=58) of eligible patients had documentation of TB screening. Measurement of disease activity and functional status rose significantly each year from 2010 to 2012 (72.8 to 94%, p < 0.0001 and 70.8% to 93.3%, p < 0.0001 respectively). None of the patients had documentation of disease prognosis. Documentation of a glucocorticoid management plan was done in 60% (N=5) of the patients who required it. 48.9% (N=174) of patients either did not take glucocorticoids or received glucocorticoids but did not meet the criteria to require a management plan. 98.8% (N=328) of eligible patients were treated with a DMARD. 61% (N=215) of patients on a DMARD required intervention for increased disease activity, of which 100% received it.
The majority of patients had documentation of TB screening. Our assessment of disease activity and functional status improved significantly over time, likely due to increasing provider awareness of quality metrics. Although most patients were stratified and treated as per disease severity, their prognosis was not documented. Only a small percentage of our patients met the criteria requiring a glucocorticoid management plan, thus limiting our assessment of this quality indicator. Our clinic had excellent adherence to treatment with DMARDs, as well as managing worsening disease.
A limitation of our study was a lack of electronic medical records (EMR), which may have negatively impacted data collection. As a result, actual rates of adherence may have been higher than those measured.
Better adherence to guidelines and documentation is required, especially with regards to assessment and classification of disease prognosis, which could be achieved through provider education. In addition, an automated EMR reminder to obtain TB screening upon ordering a biologic treatment may further improve documentation of this QI.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-acr-endorsed-quality-indicators-in-rheumatoid-arthritis-patients-a-quality-improvement-initiative/