Receipt of Disease-Modifying Antirheumatic Drugs Among Patients With Rheumatoid Arthritis in Medicare Managed Care Plans

Abstract

Context In 2005, HEDIS introduced a quality measure to assess the receipt of disease modifying anti-rheumatic drugs (DMARDs) among patients with rheumatoid arthritis (RA). Objective To identify sociodemographic, community, and health-plan factors associated with DMARD receipt among Medicare managed care enrollees. Design, Setting, and Patients We analyzed individual-level HEDIS data for 93,143 patients ≥ 65 years old with at least 2 diagnoses of RA within a measurement year (during 2005–2008). Logistic regression models with generalized estimating equations were used to determine factors associated with DMARD receipt. We used logistic regression to adjust health plan performance for case-mix. Main Outcome Measure DMARD receipt (yes/no). Results The mean age of patients was 74 years; 75% were female, and 82% were white. Overall performance on the HEDIS RA measure was 59% in 2005, rising to 67% in 2008 (p for trend <.01). The largest difference in performance was based on age: patients ≥ 85 had a 30% (29%, 32%), p<.001) point lower rate of DMARD receipt compared to patients 65–69, even after adjusting for other factors. Males (−3%, 95% CI (−5%, −2%), p<.001), blacks (−4%, 95% CI (−6%, −2%), p<.001), patients with low personal income(−6%, 95% CI (−8%,−5%), p<.001), and those with the lowest ZIP-code-based socioeconomic status (SES) (−4%, 95% CI (−6%,−2%), p<.001) were also found to have lower percentage point rates, as were patients in the Middle (−7%, 95% CI (−13%,−2%), p<.001) and South Atlantic regions (−11%, 95% CI (−20%,−3%), p<.001, compared to the Pacific) and patients enrolled in for-profit health plans (−4%, 95% CI (−7%,−0%), p<.001). Performance varied widely by health plan, ranging from 16% to 87%. Conclusions Among Medicare managed care enrollees carrying a diagnosis of RA between 2005 and 2008, 63% received a DMARD; DMARD receipt varied based on demographic factors, SES, geographic location, and health plan.

A Retrospective Analysis of Corticosteroid Utilization Before Initiation of Biologic DMARDs Among Patients with Rheumatoid Arthritis in the United States

“…To be included, a patient had to have at least two diagnoses of RA at least a week apart within a year in an ambulatory or non-acute setting [9,13,14]. The earliest date a patient was diagnosed with RA was identified as the index date as long as there was a six-month washout period before the date of diagnosis.…”

Methods for Developing the American College of Rheumatology's Electronic Clinical Quality Measures

“…Early quality measures in rheumatology relied on administrative billing claims (1,2). Such measures have the advantage of collecting information from all of the clinicians and entities that have submitted bills for clinical care, thus capturing a broad picture of health care received.…”

“…Previous quality measurement efforts have relied on analyses of administrative billing claims, such as the National Committee on Quality Assurance disease-modifying antirheumatic drug measure (1), or on manual chart review, such as the American Medical Association's Physician Consortium for Performance Improvement's (PCPI) Physician Quality Reporting System measures (2). While there is some evidence that these programs have resulted in quality improvement, many have argued that current performance assessments have limited utility and do not support building a continuously learning health care system, as envisioned by the Institute of Medicine (1)(2)(3).…”

Population Variations in Rheumatoid Arthritis Treatment and Outcomes, Northern California, 1998–2009

“…The frequency of DMARD use (number of patients with at least 1 dispensing in each year) ranged from 16% to 87% in 245 Medicare managed care plans (2005)(2006)(2007)(2008), compared with 75% to 83% in the present study. 15 In the National Ambulatory Medical Care Survey, 1996-2007, DMARD was examined at the unit of the visit and not the patient, with 47% of 859 visits across the entire study period having documentation of DMARD use. 16 In the TennCare population, the proportion of patients with RA (N = 23,342) who received at least 1 dispensing of anti-TNF or nonbiologic DMARD increased from 1995 through 2004, from 62% to 71%.…”