title: American College of Rheumatology quality indicators for rheumatoid arthritis: benchmarking, variability, and opportunities to improve quality of care using the electronic health record.
abstract: 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.
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania 17822-1341, USA.
authors.forename: Leena G
authors.initials: LG
authors.lastname: Adhikesavan
authors.forename: Eric D
authors.initials: ED
authors.lastname: Newman
authors.forename: Mark P
authors.initials: MP
authors.lastname: Diehl
authors.forename: G Craig
authors.initials: GC
authors.lastname: Wood
authors.forename: Androniki
authors.initials: A
authors.lastname: Bili
mesh_terms: 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
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate