title: Rheumatoid arthritis quality measures and radiographic progression.
abstract: OBJECTIVE
  Documentation of quality measures (QMs) in rheumatoid arthritis (RA) is used as a surrogate for measure of quality of care, but the association of this documentation with radiographic outcomes is uncertain. We examined documentation of RA QMs, for disease activity and functional status and the association with radiographic outcomes.
  
  
  METHODS
  Data were analyzed for 438 RA patients in a longitudinal cohort with complete data on van der Heijde-modified Total Sharp Score (TSS). All rheumatologist (N = 18) notes in the electronic medical record during a 24-month period were reviewed for RA QMs. Any mention of disease activity categorized as low, moderate, or high was considered documentation of the QM for disease activity. Functional status QM documentation included any mention of the impact of RA on function. Change in TSS was quantified with progression defined as ≥1 unit per year. We compared percent of visits with an RA QM documented and mean change in TSS.
  
  
  RESULTS
  The mean age in the cohort was 56.9 years, disease duration was 10.8 years, baseline DAS28 score was 3.8 (±1.6), 67.7% were seropositive, and 33.9% used a biologic DMARD. Radiographic progression was observed in 28.5%. Disease activity was documented for 29.0% of patient visits and functional status in 74.7%; neither had any significant relationship to mean TSS change (both P > 0.10).
  
  
  CONCLUSIONS
  The documentation of RA QMs was infrequent and not associated with radiographic outcomes over 24 months.
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham & Women's Hospital, 75 Francis St, PBB-B3, Boston, MA 02115. Electronic address: sdesai5@partners.org.
authors.forename: Sonali P
authors.initials: SP
authors.lastname: Desai
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham & Women's Hospital, 75 Francis St, PBB-B3, Boston, MA 02115.
authors.forename: Chih-Chin
authors.initials: CC
authors.lastname: Liu
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham & Women's Hospital, 75 Francis St, PBB-B3, Boston, MA 02115.
authors.forename: Heather
authors.initials: H
authors.lastname: Tory
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham & Women's Hospital, 75 Francis St, PBB-B3, Boston, MA 02115.
authors.forename: Tabatha
authors.initials: T
authors.lastname: Norton
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham & Women's Hospital, 75 Francis St, PBB-B3, Boston, MA 02115.
authors.forename: Michelle
authors.initials: M
authors.lastname: Frits
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Siri
authors.initials: S
authors.lastname: Lillegraven
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham & Women's Hospital, 75 Francis St, PBB-B3, Boston, MA 02115.
authors.forename: Michael
authors.initials: M
authors.lastname: Weinblatt
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham & Women's Hospital, 75 Francis St, PBB-B3, Boston, MA 02115.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Coblyn
authors.affiliation: Division of Rheumatology, Department of Medicine, University of San Francisco, San Francisco, CA.
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham & Women's Hospital, 75 Francis St, PBB-B3, Boston, MA 02115.
authors.forename: Nancy
authors.initials: N
authors.lastname: Shadick
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham & Women's Hospital, 75 Francis St, PBB-B3, Boston, MA 02115; Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D011859:Radiography; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents
keywords: Quality measures; Radiographic progression; Rheumatoid arthritis