title: Development of the American College of Rheumatology's Rheumatoid Arthritis Electronic Clinical Quality Measures.
abstract: Electronic clinical quality measures (eCQMs) rely on computer algorithms to extract data from electronic health records (EHRs). On behalf of the American College of Rheumatology (ACR), we sought to develop and test eCQMs for rheumatoid arthritis (RA).
  
  
  
  Drawing from published ACR guidelines, a working group developed candidate RA process measures and subsequently assessed face validity through an interdisciplinary panel of health care stakeholders. A public comment period followed. Measures that passed these levels of review were electronically specified using the quality data model, which provides standard nomenclature for data elements (category, datatype, and value sets) obtained through an EHR. For each eCQM, 3 clinical sites using different EHR systems tested the scientific feasibility and validity of measures. Measures appropriate for accountability were presented for national endorsement.
  
  
  
  Expert panel validity ratings were high for all measures (median 8-9 of 9). Health system performance on the eCQMs was 53.6% for RA disease activity assessment, 69.1% for functional status assessment, 93.1% for disease-modifying antirheumatic drug (DMARD) use, and 72.8% for tuberculosis screening. Kappa statistics, which evaluated whether the eCQM validly captured data obtained from manual EHR chart review, demonstrated moderate to substantial agreement (0.54 for functional status assessment, 0.73 for tuberculosis screening, 0.84 for disease activity, and 0.85 for DMARD use).
  
  
  
  Four eCQMs for RA have achieved national endorsement and are recommended for use in federal quality reporting programs. Implementation and further refinement of these measures is ongoing in the ACR's registry, the Rheumatology Informatics System for Effectiveness (RISE).
authors: University of California, San Francisco. jinoos.yazdany@ucsf.edu.
authors: Jinoos
authors: J
authors: Yazdany
authors: Harvard Vanguard Medical Associates, Atrius Health, Somerville, Massachusetts.
authors: Mark
authors: M
authors: Robbins
authors: University of California, San Francisco.
authors: Gabriela
authors: G
authors: Schmajuk
authors: Brigham & Women's Hospital, Boston, Massachusetts.
authors: Sonali
authors: S
authors: Desai
authors: University of British Columbia, Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada.
authors: Diane
authors: D
authors: Lacaille
authors: Boston University School of Medicine, Boston, Massachusetts.
authors: Tuhina
authors: T
authors: Neogi
authors: University of Alabama at Birmingham, Palo Alto, California.
authors: Jasvinder A
authors: JA
authors: Singh
authors: Stanford University Medical Center, Palo Alto, California.
authors: Mark
authors: M
authors: Genovese
authors: American College of Rheumatology, Atlanta, Georgia.
authors: Rachel
authors: R
authors: Myslinski
authors: American College of Rheumatology, Atlanta, Georgia.
authors: Natalie
authors: N
authors: Fisk
authors: American College of Rheumatology, Atlanta, Georgia.
authors: Melissa
authors: M
authors: Francisco
authors: Geisinger Medical Center, Danville, Pennsylvania.
authors: Eric
authors: E
authors: Newman
mesh_terms: D000465:Algorithms; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D057286:Electronic Health Records / Q000706:statistics & numerical data; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012042:Registries; D015203:Reproducibility of Results; D012219:Rheumatology / Q000592:standards*; D012955:Societies, Medical / Q000592:standards; D014481:United States
chemical_list: D018501:Antirheumatic Agents