Background/Purpose: The purpose of this study was to operationalize and report on 3 Rheumatoid Arthritis (RA) performance measures previously identified in the Patient-Centered Framework for Measuring, Monitoring and Optimizing RA care in Canada: 1) the number of visits where a patient was in moderate or high disease activity where a follow-up visit was booked within ≤ 3 months; 2) the number of visits with moderate or high disease activity where the disease activity was subsequently documented as low or in remission within 6 months; 3) the percentage of patients in remission at any point during the measurement period.

Methods: The performance measures were tested in an RA cohort over the period between 08/2016 to 05/2019 using a web-based tool (Rheum4U). Rheum4U is designed as a pragmatic quality improvement and research tool and collects baseline characteristics, sociodemographic factors, patient reported outcomes, and disease activity using composite scores (DAS28) calculated at the point of care. The study was conducted at 2 outpatient University-affiliated rheumatology clinics staffed by 15 participating rheumatologists and 1 nurse practitioner. Consecutive patients were recruited and consented for inclusion at any point during their disease course and data entered into the Rheum4U platform at each clinical encounter, with the timing of encounters and treatment changes being at the discretion of the attending rheumatologist and patient. Standard DAS28 cutoffs for disease activity were used in the study.

Results: 500 patients with RA (with n=1627 visits) were included in the analysis, 75% were female with a mean (SD) age of 55 (14) years. The mean length of follow-up was 413 (238) days and the mean number of visits was 4 (2) for patients with > 1 visit. There was a disease activity score (DAS28) calculated at 1202 of the 1627 visits (74%). 503 visits (42% of visits with a DAS28 score) were in patients with moderate or high disease activity with at least 1 follow-up. Amongst all visits (n=503) for patients with a documented moderate or high disease activity score, 147 follow-up visits (30%) occurred within ≤ 3 months and low disease activity or remission was achieved at 100 visits (20%) within ≤ 6 months. The percentage of visits where the patient was documented to be in remission at any point over follow-up was 35% (n=425/1202 with a DAS28 score) and an additional 6% were in low disease activity (n=67).

Conclusion: While just over 40% of patients reached a state of remission or low disease activity over the follow-up period, we have identified critical areas for process and outcome improvements. Specifically, only 30% of visits where a moderate or high disease activity was documented had a follow-up visit within 3 months, and only 20% of follow-up visits documented low disease activity or remission within 6 months. This work highlights the importance of quality measures as a tool to help guide adherence to treat-to-target strategies.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/testing-rheumatoid-arthritis-performance-measures-to-optimize-treat-to-target-strategies/