Background/Purpose: The American College of Rheumatology’s Rheumatology Informatics System for Effectiveness (RISE) is an EHR-enabled registry that facilitates quality measure reporting to national pay-for-performance programs. Whether participation in the registry is associated with improved quality of care remains unknown. This study examined changes in practice-level quality measure performance before and after joining RISE.

Methods: We evaluated performance on 6 rheumatology-specific quality measures among practices that joined RISE between 2015 – 2020, using data from before RISE enrollment (via historical EHR data) and after enrollment. For each month (from 12 months before joining RISE to 24 months after enrollment), we calculated measure performance among patients with ≥1 visit during the preceding 12-month period. Measures included QPP39: osteoporosis screening, QPP178: RA functional status assessment, QPP177: RA periodic disease activity assessment, QPP176: Tuberculosis (TB) screening, ACR10: Hepatitis B (HBV) screening, and ACR09: RA low disease activity or remission. To ensure stable performance estimates, practices with < 20 patients in the denominator at any time were excluded from the analysis for that measure. We used an interrupted time series (ITS) analysis to assess changes in practice-level performance before vs. after RISE registry enrollment. We repeated this analysis stratified by practices’ baseline performance (above vs. below the median).

Results: Overall, we included 81 practices caring for 339,745 patients; most were single-specialty practices (60%) and used the EHR vendor Nextgen (36%). Performance on all 6 measures improved after practices joined RISE. Performance typically improved within the first month after joining the registry and continued on an upward trajectory over subsequent months (see Figure). Based on the ITS analysis, all measures had significant post-intervention linear trends with increases ranging from 0.01-0.92 percentage points per month, P_all< 0.05; RA periodic assessment of disease activity and RA functional status assessment displayed the largest increases in performance per month (0.78 and 0.92 percentage points, respectively). In the stratified analysis, performance improved at a higher rate among practices whose baseline performance was below the median, except for HBV screening, where trajectories were more flat (Figure).

Conclusion: In this interrupted time series analysis, enrollment in the RISE registry was associated with significant improvements in performance across 6 rheumatology-specific quality measures. Improvements were most marked for practices with lower baseline performance. These results underscore the potential for registry participation to enhance the quality of rheumatologic care. Future work is needed to explore the mechanisms through which the RISE registry drives these improvements.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rise-registry-associated-with-significant-gains-in-quality-measure-performance-an-interruptedtimes-series-analysis-before-and-after-participation/