American College of Rheumatology quality indicators for rheumatoid arthritis: benchmarking, variability, and opportunities to improve quality of care using the electronic health record.
OBJECTIVE
To measure how rheumatologists across our health system performed with the American College of Rheumatology (ACR) quality indicators (QIs) for rheumatoid arthritis (RA) and methotrexate (MTX) drug safety, and to develop opportunities for improvement.


METHODS
An electronic health record (EHR) review of 1,062 unique RA patients seen by 15 rheumatologists in a 1-year period was performed. Percentage of each QI met, reasons why the metric was not met, and performance of rheumatologists based on years of experience were evaluated.


RESULTS
The percentage met was high for QI-2 (RA disease-modifying antirheumatic drug use; 94%), QI-3 (intervention if RA worse; 85%), and QI-4 (MTX risks discussion; 87%). Percentage met was lower for QI-1 (RA core data set; 69%), QI-5 (MTX baseline studies; 41%), and QI-6 (MTX followup studies; 46%). QI-1 and QI-5 were low due to most physicians missing a single test, and QI-6 was low because of few physicians driving the percentage down. Better QI performance was seen in rheumatologists with <or=10 years versus >10 years of experience for QI-1 (90% versus 64%; odds ratio [OR] 4.21, P = 0.004) and QI-3 (96% versus 82%; OR 4.47, P = 0.019). EHR chart review for this population required 179.3 hours.


CONCLUSIONS
Measurement allows us to better understand the quality of care that we deliver. In this systematic benchmarking of the ACR QIs in a large RA cohort, performance was excellent in RA treatment-related QIs. Significant variability was noted in RA and MTX monitoring measures, which can be addressed using process redesign techniques.
Adhikesavan
Leena G
LG
Geisinger Medical Center, Danville, Pennsylvania 17822-1341, USA.
Newman
Eric D
ED
Diehl
Mark P
MP
Wood
G Craig
GC
Bili
Androniki
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D019985:Benchmarking; D002983:Clinical Competence; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008727:Methotrexate / Q000009:adverse effects; D008875:Middle Aged; D011787:Quality of Health Care; D012219:Rheumatology / Q000592:standards*; D014481:United States
D018501:Antirheumatic Agents; D008727:Methotrexate