Background/Purpose: Improvement in quality of care is of growing interest to both physicians and payers. Both the American College of Rheumatology and National Quality Forum (NQF) recommend monitoring of quality measures in rheumatoid arthritis (RA) patients. The purpose of this study is to describe the proportion of RA patients in a large managed care population that achieved NQF quality measures specific to RA.

Methods: This is a retrospective analysis of Humana’s Commercial and Medicare database. Claims were reviewed to evaluate compliance with four NQF quality measures in calendar year 2011. NQF definitions were used for the numerator (N) and the denominator (D) for each measure. Descriptive statistics were calculated on the specific measures.

Results: The proportion of adult RA patients who received at least one prescription for a DMARD (measure 0054) was 72.8%  (N=17,066, D=23,440). Liver function testing in patients with a new DMARD as defined by measure 0590 was achieved by 84.7% (N=3,130, D=3,694) of adult RA patients. The proportion of newly diagnosed adult patients receiving a baseline ESR or CRP (measure 0601) was 54.7% (N=2,595, D=4,742). For measure 0592 the proportion of adult patients receiving an annual ESR or CRP was 58.2% (N=13,125, D=22,538).

Conclusion: This analysis of an RA population in a large managed care population suggests that 15% to 45% of patients do not attain NQF quality measure standards.  These findings suggest that improvements in patient care could be made with the goal of improving the proportion of patients achieving RA specific NQF measures. Further studies are warranted to understand whether attainment of these measures translates into better overall health or RA-related outcomes and may enhance physician and patient awareness about the benefits of quality of care.