Embed Size (px)
Citation preview
© 2015 1
R H E U M A T O I D A R T H R I T I S P R A C T I C E P E R F O R M A N C E ( R A P P ) P R O J E C T
Erin Arnold1 | William Arnold1 | James Bower2 | Douglas Conaway3 J Timothy Harrington2 | Drew Johnson2 | James Mossell4
Joy Schechtman5 | Anne Winkler6
1Orthopaedics and Rheumatology of the North Shore, Skokie, IL 2Joiner Associates LLC, Madison, WI 3Carolina Health Specialists, Myrtle Beach, SC 4ArthriGs and Osteoporosis Center of South Georgia LLC, TiJon, GA 5Sun Valley ArthriGs Center LTD, Peoria, AZ 6Winkler Medical PracGce LLC, Springfield, MO
Poster Presented at the 2015 ACR/ARHP Annual MeeJng November 6-‐11, 2015 | San Francisco, CA | Abstract #2487
© 2015 2
R H E U M A T O I D A R T H R I T I S P R A C T I C E P E R F O R M A N C E ( R A P P ) P R O J E C T
Background/Purpose PopulaGon management (PM) offers a promising approach to providing Treat-‐to-‐Target (T2T) care for rheumatoid arthriGs (RA). PM depends on providing standardized, on-‐Gme disease acGvity (DA) assessments and coordinated care across the enGre disease populaGon, as well as for individual paGents within this context. This study invesGgates the adopGon of PM registries in rheumatology pracGces, the use of standardized DA measures (referred to as signal measures) as chosen by parGcipaGng rheumatologists, and the barriers
Methods The Rheumatoid ArthriGs PracGce Performance (RAPP) Project is a voluntary collaboraGon of U.S. clinician rheumatologists (current N = 168) who manage more than 80,000 RA paGents in total. ParGcipaGng physicians are enrolling their RA paGents (ICD-‐9 code 714.0) into a HIPAA-‐compliant disease populaGon registry from pracGce billing records or during clinical visits. They are then collecGng signal measures and current medicaGons on these paGents over Gme. With isolated excepGons, their preferred signal measures include one or more of the following: RAPID3, a 0-‐10 Provider Global Assessment (PGA), Clinical Disease AcGvity Index (CDAI), and a mulG-‐biomarker (MB) test. The registry enables real-‐Gme PopulaGon Reports that track assessment Gmeliness (consistent with T2T recommendaGons) and monitor the DA distribuGon within each physician’s enrolled RA populaGon. Lists of overdue paGents are also generated from the registry. The RAPP Project’s coordinators regularly assess physicians’ progress toward PM and the barriers they encounter.
Results To this point, 86 RAPP Project physicians have fully enrolled their RA populaGon in a populaGon registry. Signal measure results reported by these physicians include: PracGces % of PaGents Total PaGents in Measure ReporGng (N) Reported (Range) All Registries (N) RAPID3 15 10-‐93% 4176 PGA 39 2-‐93% 8679 CDAI 15 2-‐93% 4151 MB Test 86 3-‐100% 38412
Despite strong intenGons, many pracGces encounter barriers to implemenGng a populaGon registry and PM workflows, including: 1) temporary pracGce or personal crises, such as partners leaving or illnesses; 2) physicians and staff lacking the Gme, resources, and skills to implement the necessary pracGce changes; and 3) administraGve objecGons, especially in larger group pracGces.
Conclusion 1. Increasing numbers of physicians and staff have been able to implement a simple yet robust populaGon registry in their busy pracGce environments. 2. They are collecGng one or more signal measures across their populaGon. 3. Both pracGce-‐based and health system barriers present challenges to implemenGng PM in many pracGces.
© 2015 3
R H E U M A T O I D A R T H R I T I S P R A C T I C E P E R F O R M A N C E ( R A P P ) P R O J E C T
The Rheumatoid ArthriJs PracJce Performance (RAPP) Project is a voluntary collaboraGon of 168 U.S. clinician rheumatologists who manage more than 80,000 rheumatoid arthriGs (RA) paGents in total. Clinical populaJon management offers a promising approach to providing Treat-‐to-‐Target care for RA. It depends on providing standardized, on-‐Gme disease acGvity assessments and coordinated care across the enGre disease populaGon, as well as for individual paGents within this context. This study invesJgates the adopGon of clinical populaGon management registries in rheumatology pracGces, the use of standardized disease acGvity measures (referred to as signal measures) as chosen by parGcipaGng rheumatologists, and the barriers some pracGces are encountering as they strive to implement clinical populaGon management.
© 2015 4
R H E U M A T O I D A R T H R I T I S P R A C T I C E P E R F O R M A N C E ( R A P P ) P R O J E C T
Dataflow Process: We developed a simple, doable clinical populaGon management process.
PopulaJon data and paJent work lists
PracJce team
3 Analyze
populaJon data
2 Enter data in populaJon registry
PopulaJon registry
PaJent Data CollecJon Sheet
Physician/ pracJce team
1 Document paJent data
PracJce staff or designated registry manager
4 Improve care and workflows
STEP
TO
OLS
WHO
© 2015 5
R H E U M A T O I D A R T H R I T I S P R A C T I C E P E R F O R M A N C E ( R A P P ) P R O J E C T
Table 1. PracJce ParJcipaJon. To this point, 86 RAPP Project physicians have fully enrolled their RA paGent populaGon in a populaGon registry.
Aaended RAPP Project Advisory Board MeeJng 172
Commiaed to RAPP Project ParJcipaJon 168
Implemented a PopulaJon Registry
Fully Enrolled RA PopulaJon in Registry 86
RouJnely Entering DA Measures in Registry 86
112 yes 56 no
© 2015 6
R H E U M A T O I D A R T H R I T I S P R A C T I C E P E R F O R M A N C E ( R A P P ) P R O J E C T
Table 2. Disease AcJvity Measures Reported. Among the 86 RAPP Project physicians with fully enrolled registries, four signal measure results were reported.
Measure Practices Reporting
(N)
% of Patients Reported
(Range)
Total DA Measures
Reported (N)
RAPID3 15 10-‐93% 4,441
PGA 39 2-‐93% 9,338
CDAI 15 2-‐93% 4,377
MB Test 86 3-‐100% 41,928
© 2015 7
R H E U M A T O I D A R T H R I T I S P R A C T I C E P E R F O R M A N C E ( R A P P ) P R O J E C T
Table 3. PopulaJon Registry ImplementaJon by PracJce Environment. Despite strong intenGons, many pracGces encounter barriers to implemenGng a populaGon registry and clinical populaGon management workflows, including: 1) temporary pracGce or personal crises, such as partners leaving or illnesses; 2) physicians and staff lacking the Gme, resources, and skills to implement the necessary pracGce changes; and 3) administraGve objecGons, especially in larger group pracGces.
Yes No Registry Implemented Number of
PracJces
Single Specialty
MulJspecialty/Integrated System
Chi-‐square is 10.0176. P value is 0.0015. This result is significant at p < 0.05.
Type of PracJce
112 67 45 56 19 37
60% 40%
34% 66%
© 2015 8
R H E U M A T O I D A R T H R I T I S P R A C T I C E P E R F O R M A N C E ( R A P P ) P R O J E C T
1. Increasing numbers of physicians and staff have been able to implement a simple yet robust populaGon registry in their busy pracGce environments.
2. They are collecGng one or more signal measures across their populaGon.
3. Both pracGce-‐based and health system barriers present challenges to implemenGng clinical populaGon management in many pracGces.
Disclosures E Arnold, W Arnold, J Bower, D Conaway, JT Harrington, J Mossell, Crescendo Bioscience5 | W Arnold, D Conaway, J Mossell, J Schechtman, A Winkler, Crescendo Bioscience8 | D Johnson, Crescendo Bioscience3 (formerly) | Joiner Associates LLC received consulGng fees from Crescendo Bioscience for designing and coordinaGng the Rheumatoid ArthriGs PracGce Performance (RAPP) Project – without any influence from the company | Crescendo Bioscience provided consulGng fees to Joiner Associates and support for RAPP Project advisory board meeGngs 3Employment (full or part Gme) | 5ConsulGng fees or other remuneraGon (payment) 8Speaker’s bureau
