Abstract:Background-Electronic clinical quality measures (eCQMs) rely on computer algorithms to extract data from electronic health records (EHRs). On behalf of the American College of Rheumatology (ACR), we sought to develop and test eCQMs for rheumatoid arthritis (RA).
“…In rheumatology, organizations such as the American College of Rheumatology (ACR) in the US and the National Institute for Health Care Excellence (NICE) in the UK have developed quality indicators 3, 4 and quality standards 5 as tools for monitoring and improving the quality of care provided to patients with rheumatoid arthritis (RA).Significance & Innovations
There was evidence of a high level of adherence to performance measures for early treatment and followup in early rheumatoid arthritis (RA) patients from rheumatology clinics across Canada who were enrolled in a prospectively followed cohort.Measuring adherence to performance measures using an established early RA cohort is feasible and may be used for benchmarking in other settings.
…”
ObjectiveTo assess adherence to 3 system‐level performance measures in a national early rheumatoid arthritis (RA) cohort.MethodsPatients enrolled in the Canadian Early Arthritis Cohort (2007–2015) who met 1987 or 2010 American College of Rheumatology/European League Against Rheumatism criteria with <1 year of symptom duration and ≥1 year of followup after enrollment were included. Performance measures assessed were the percentage of RA patients seen in yearly followup, and the number of gaps between visits of >12 or >14 months, the percentage of RA patients treated with a disease‐modifying antirheumatic drug (DMARD), and days from RA diagnosis to initiation of a DMARD. Results are shown stratified by enrollment year to assess for temporal changes in performance.ResultsA total of 1,763 early RA patients were included (mean age 54 years, 73% female, and 82% white). At enrollment, mean ± SD disease duration was 6 ± 3 months, and Disease Activity Score in 28 joints was 5.1 ± 1.5. Over 8 years, the proportion of patients seen in annual followup declined from 100% to 91%. Over followup, 42% of patients had 0 gaps in care of >12 months, and 64% had 0 gaps >14 months. The percentage of DMARD‐treated early RA patients was and remained high (95–87%), and the percentage receiving DMARDs within 14 days of diagnosis was 75%. Median time‐to‐DMARD therapy was 1 day, indicating DMARDs were initiated at diagnosis (90th percentile 93 days).ConclusionThere was evidence of high adherence to system‐level performance measures in this early RA cohort following a protocol. Small declines in performance were noted with increasing length of patient followup. Our findings are useful for performance measure benchmarking.
“…In rheumatology, organizations such as the American College of Rheumatology (ACR) in the US and the National Institute for Health Care Excellence (NICE) in the UK have developed quality indicators 3, 4 and quality standards 5 as tools for monitoring and improving the quality of care provided to patients with rheumatoid arthritis (RA).Significance & Innovations
There was evidence of a high level of adherence to performance measures for early treatment and followup in early rheumatoid arthritis (RA) patients from rheumatology clinics across Canada who were enrolled in a prospectively followed cohort.Measuring adherence to performance measures using an established early RA cohort is feasible and may be used for benchmarking in other settings.
…”
ObjectiveTo assess adherence to 3 system‐level performance measures in a national early rheumatoid arthritis (RA) cohort.MethodsPatients enrolled in the Canadian Early Arthritis Cohort (2007–2015) who met 1987 or 2010 American College of Rheumatology/European League Against Rheumatism criteria with <1 year of symptom duration and ≥1 year of followup after enrollment were included. Performance measures assessed were the percentage of RA patients seen in yearly followup, and the number of gaps between visits of >12 or >14 months, the percentage of RA patients treated with a disease‐modifying antirheumatic drug (DMARD), and days from RA diagnosis to initiation of a DMARD. Results are shown stratified by enrollment year to assess for temporal changes in performance.ResultsA total of 1,763 early RA patients were included (mean age 54 years, 73% female, and 82% white). At enrollment, mean ± SD disease duration was 6 ± 3 months, and Disease Activity Score in 28 joints was 5.1 ± 1.5. Over 8 years, the proportion of patients seen in annual followup declined from 100% to 91%. Over followup, 42% of patients had 0 gaps in care of >12 months, and 64% had 0 gaps >14 months. The percentage of DMARD‐treated early RA patients was and remained high (95–87%), and the percentage receiving DMARDs within 14 days of diagnosis was 75%. Median time‐to‐DMARD therapy was 1 day, indicating DMARDs were initiated at diagnosis (90th percentile 93 days).ConclusionThere was evidence of high adherence to system‐level performance measures in this early RA cohort following a protocol. Small declines in performance were noted with increasing length of patient followup. Our findings are useful for performance measure benchmarking.
“…From the 13 sources ( 16,17 , and 1 was a pan-European set 18 ). Most of the sets were for RA 6,7,9,11,12,13,[15][16][17][18] (n = 10, 77%) with 1 each (8%) for JIA 10 , PsA 14 , and inflammatory arthritis 8 . No sets were found for ReA and none accepted for AS.…”
Section: Resultsmentioning
confidence: 99%
“…Similarly, there was variability in the consensus procedures used to finalize the measurement sets: a modified Delphi in conjunction with Nominal Group Technique in 1 set 10 , a modified RAND/University of California, Los Angeles (UCLA) Appropriateness Method in 4 sets 11,12,16,17 , an online modified Delphi using a platform called ExpertLens (RAND Corp.) in 3 sets 6,7,8 , a modified Delphi in another 17 , and other study-specific consensus methods in 4 sets 9,13,14,15 .…”
Section: Rheumatologymentioning
confidence: 99%
“…Interestingly, only a few of these attributes are routinely reported in the studies describing the measure development of the inflammatory arthritis measure sets in this review. For example, to be accepted, quality measures needed variably to be valid 11 , valid and feasible 7,12 , valid and important 6 , valid and relevant 8 , relevant 17 , and applicable and feasible 18 . A few sets did not follow any published attributes for measure development and used the following statements for consensus development: "adequately reflected the quality of disease course monitoring" 16 , "consistent with [previous] recommendations" 9 , or simply included measures with higher "priority" rankings 10,13,14,24 .…”
Section: Rheumatologymentioning
confidence: 99%
“…We also recommend that the feasibility of measures should be tested prior to implementation. Prior testing appeared to occur infrequently in the reviewed measurement sets, except for the American College of Rheumatology's RA quality measure set, which was tested in a new electronic clinical care registry (Rheumatology Informatics System for Effectiveness) prior to publication 12 , and the Eumusc.net measures, where the initial set was audited with questions involving applicability and feasibility before using that feedback to develop the final set. This concept of testing feasibility prior to implementation was not included in the AGREE II tool and may have led to a biased assessment of a measurement set's quality.…”
ABSTRACT. Objective. To conduct a systematic review and quality appraisal of quality measures for inflammatory arthritis, including rheumatoid arthritis (RA), spondyloarthritis, psoriatic arthritis (PsA), and juvenile idiopathic arthritis (JIA). Methods. Embase, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from January 1, 2000, to October 23, 2016, using Medical Subject Headings terms for inflammatory arthritis and quality measures. A "grey literature" search of international arthritis organizations and quality measure libraries was also conducted. Two reviewers independently considered the papers for inclusion, with disagreements resolved by consensus. A modified guideline appraisal tool (AGREE II) was used to appraise the measure development process, which determined final inclusion. Quality measures are tools for measuring whether care provided is concordant with evidence-based practices. They often represent minimum standards of care and are derived from quality indicators, which are statements about best practices that are associated with high-quality care. Quality indicators are usually specified in the following format: If (a specific clinical scenario), then (a clinical action) 1 . An oftencited example of a quality indicator would be if a patient has rheumatoid arthritis (RA), then they should be prescribed a disease-modifying antirheumatic drug (DMARD) 1 . Quality indicators can be further specified into quality measures, which have a specific numerator, denominator, and exclusions and can be reported as a percentage representing a quality or performance measure (depending on whether the subject of measurement is associated with improved quality or just healthcare performance). Quality measures can be used for benchmarking and quality improvement efforts, and in some countries and jurisdictions, are used in pay-forperformance programs. An example of a quality measure based on the above quality indicator would be "the percentage of patients with RA who have been prescribed a DMARD." According to a classic Donabedian framework 2 , quality measures are often classified into process, structure, or outcome. Process measures determine whether clinical processes are concordant with evidence-based best practice and improved patient outcomes; structure measures record whether the health system or clinic infrastructures are present
RheumatologyThe Journal of on May 11, 2018 -Published by www.jrheum.org Downloaded from to support best practices; and outcome measures determine the effect on the health status of the patient. While outcome measures may seem the most obvious to measure, patient outcomes are the result of many factors, some of which are beyond the control of physicians. Several domains of quality exist, and the most commonly cited framework is the Institute of Medicine's 6 Domains of Health Care Quality 3 : safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.The present systematic review of quality measures in rheumatology was...
Background
The Rheumatology Informatics System for Effectiveness (RISE) is a national electronic medical record (EMR)-enabled registry. RISE passively collects data from EMRs of participating practices, provides advanced quality measurement and data analytic capacities, and fulfills national quality reporting requirements. Here we report the registry’s architecture and initial data, and demonstrate how RISE is being used to improve the quality of care.
Methods
RISE is a certified Centers for Medicare and Medicaid Services Qualified Clinical Data Registry, allowing collection of data without individual patient informed consent. We analyzed data between October 1, 2014 and September 30, 2015 to characterize initial practices and patients captured in RISE. We also analyzed medication use among rheumatoid arthritis (RA) patients and performance on several quality measures.
Results
Across 55 sites, 312 clinicians contributed data to RISE; 72% were in group practice, 21% in solo practice and 7% were part of a larger health system. Sites contributed data on 239,302 individuals. Among the subset with RA, 34.4% of patients were on a biologic or targeted synthetic DMARD at their last encounter, and 66.7% were receiving a non-biologic DMARD. Examples of quality measures include: 55.2% had a disease activity score recorded, 53.6% a functional status score, and 91.0% were taking a DMARD in the last year.
Conclusion
RISE provides critical infrastructure for improving the quality of care in rheumatology and is a unique data source to generate new knowledge. Data validation and mapping is ongoing and RISE is available to the research and clinical communities to advance rheumatology.
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