title: Implementation of disease activity measurement for rheumatoid arthritis patients in an academic rheumatology clinic.
abstract: Treat-to-target is the recommended strategy for the management of rheumatoid arthritis (RA) and involves regular assessment of disease activity using validated measures and subsequent adjustment of medical therapy if patients are not in remission or low disease activity. Recommendations published in 2012 detailed the preferred disease activity measures but there have been few publications on implementation of disease activity measures in a real-world clinic setting.
  
  
  
  Plan-Do-Study-Act (PDSA) methodology was used over two cycles with a goal of increasing provider measurement of disease activity during all RA patient visits. In PDSA cycle 1, we implemented a paper-based form to help providers assess disease activity in RA patients. PDSA cycle 2 included the creation of separate patient and physician forms for collection of information, identification of patients prior to their clinic visit and incorporation of medical assistants into the workflow.
  
  
  
  The first PDSA cycle improved the number of RA patients with documented disease activity measures from 24 % over a 4-week period, to an average of 44 % over an 8-week period. The second PDSA cycle showed a sustained and dramatic improvement, with 85 % of patients having a disease activity measure recorded over a 27-week period.
  
  
  
  Implementation of disease activity measurement in a typical academic rheumatology clinic can be achieved by standardizing workflow using a simple paper form.
authors.affiliation: Division of Rheumatology, University of Washington, Harborview, 1959 NE Pacific Street, Box 356428, Seattle, WA, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Bays
authors.affiliation: Division of Rheumatology, Veterans Affairs Medical Center - San Francisco, 4150 Clement Street, Mailstop 111R, San Francisco, CA, 94121, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wahl
authors.affiliation: Division of Rheumatology, Veterans Affairs Medical Center - San Francisco, 4150 Clement Street, Mailstop 111R, San Francisco, CA, 94121, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Daikh
authors.affiliation: Division of Rheumatology, 1001 Potrero Ave, SFGH 30, San Francisco, CA, 94110, USA.
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.affiliation: Division of Rheumatology, Veterans Affairs Medical Center - San Francisco, 4150 Clement Street, Mailstop 111R, San Francisco, CA, 94121, USA. Gabriela.schmajuk@ucsf.edu.
authors.forename: Gabriela
authors.identifier: 0000-0003-2687-5043
authors.initials: G
authors.lastname: Schmajuk
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012219:Rheumatology; D012495:San Francisco; D012720:Severity of Illness Index
keywords: Disease activity; Quality improvement; Rheumatoid arthritis