Background/Purpose: Gout is a chronic inflammatory arthritis which can be effectively managed.  The American College of Rheumatology published evidenced based gout management guidelines. These guidelines are often not followed leading to unnecessary morbidity and cost. We piloted a gout management quality improvement project at one primary care site and the rheumatology department within our integrated health system.

Methods:  The primary care site included 3 internal medicine providers, 11 family medicine providers, and 441 gout patients.  We surveyed primary care providers for their preferred quality improvement strategies. These strategies included live or online continuing medical education (CME), electronic medical record reminders, nursing staff protocols, and a monthly National Quality Forum based outcome measure report card for each provider comparing their performance with peers. The Rheumatology Department included 15 rheumatologists and 800 gout patients.  An exit survey again asked for the providers’ preferred quality improvement strategies. Lastly, we compared the intervention primary care clinic results to a usual care control: another clinic that was matched for providers and gout patients. Performance data for gout patients 6 months before and after intervention were compared.  Binary logistic regression models were used to obtain estimates of odds ratios with their 95% confidence intervals (CI). Post-intervention performance in the pilot site was compared to the control site.

Results: Data analysis pre- and post- intervention is presented in Table 1. Odds Ratios with their 95% confidence intervals for primary care intervention site versus usual care control are presented in figures 1 and 2.  Survey results showed primary care providers rated live CME and electronic health record reminders the highest with an average 4/5 (5 being most effective).  Rheumatologists chose audit and feedback of their own performance compared with peers highest at 4/5.

Conclusion: Gout management significantly improved with primary care and rheumatology intervention, education and accountability.  There were significant improvements in both monitoring (P<0.0001) and goal uric acid level (P<0.0001).   Gout outcome measures improved significantly in the intervention primary care site compared to the usual care site. The provider survey suggests that CME, EHR reminders and report card feedback were the most effective at changing provider behavior. We plan a system wide implementation of this gout quality improvement project.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-gout-outcomes-using-a-disease-management-program-within-an-integrated-health-system/