Session Information
Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: Treat-to-Target
(T2T) recommendations for rheumatoid
arthritis (RA) care include standardized frequencies of disease activity (DA)
assessment based on DA level. For this study, “on time” is defined as
three-month intervals for patients with moderate or high disease activity and
six-month intervals for those with controlled or low disease activity. These
assessments are generally performed during provider-patient encounters using a
variety of clinical and laboratory measures. The actual frequencies of DA
assessments in clinical practices are investigated in this study.
Methods: The
Rheumatoid Arthritis Practice Performance (RAPP) Project is a voluntary
collaboration of U.S. clinician rheumatologists whose goal is to provide T2T
care and optimal RA disease outcomes. Of the 168 participants in the RAPP
Project, 86 have enrolled their entire RA population (ICD-9 code 714.0) in a
HIPAA-compliant disease population registry to this point and are entering
their preferred DA measures. Sorting these DA measures by date allows an
analysis of “on-time” and “overdue” percentages in each population. The 15 RA
populations in this analysis have one or more DA measures entered on at least
45% of the enrolled population, including RAPID3, a 0-10 Provider Global
Assessment (PGA), Clinical Disease Activity Index (CDAI), and/or a
multi-biomarker (MB) test. The on-time/overdue analysis for each registry uses
multi-biomarker results, as this measure is entered for the greatest number of
patients (N=11,332). The reasons for overdue DA assessments were analyzed
separately in 20 practices using a visit capacity analysis methodology
(provider visit slots available per month compared to slots needed for on-time
assessment).
Results:
|
On-time DA Assessment Analysis
|
Median
|
Ranges (N,%)
|
|
Patients enrolled/registry (N,%) |
662/100% |
413-2120 |
|
Patients assessed/registry (N,% of enrolled) |
636/81%
|
204-1560 |
|
DA distribution in 15 RA registry populations |
|
|
|
Controlled and Low DA (% of assessed) |
22% |
16-36 |
|
Moderate DA (% of assessed) |
39% |
35-45 |
|
High DA (% of assessed) |
39% |
28-47 |
|
On-time assessment rates (% of DA cohorts) |
|
|
|
Controlled and Low DA assessed within 6 months |
10% |
3-21 |
|
Moderate and high DA assessed within 3 months |
29% |
14-52 |
Similar on-time percentages were obtained for other DA
measures.
Capacity Analysis
showed that most practices had insufficient visit slots available to provide
on-time DA assessments for their population.
Conclusion: 1. RA disease activity assessments in
clinical practices are not being provided as frequently as recommended for T2T
care. 2. Until DA assessments are on time, treatment cannot be optimized. 3.
Population registries and different practice workflows are required to provide
and document on-time DA assessments.
To cite this abstract in AMA style:
Sikes D, Bower J, Johnson D, Harrington JT, Khalil R, LaCour E, Naarendorp M, Norton H, Thomas K. Rheumatoid Arthritis Disease Activity Assessment Frequencies in Clinical Practices Do Not Support Treat-to-Target Care [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/rheumatoid-arthritis-disease-activity-assessment-frequencies-in-clinical-practices-do-not-support-treat-to-target-care/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatoid-arthritis-disease-activity-assessment-frequencies-in-clinical-practices-do-not-support-treat-to-target-care/