Quality Advice from Specialty Societies

Some examples of quality measures under each of the current areas on the ACR’s clinical registry include:

• RA: History and Exam. If a patient has a confirmed diagnosis of RA, then a measure of each of the following should be documented within three months of diagnosis and at least annually thereafter: joint exam, functional status assessment, acute phase reactant, measurement of pain, physician global assessment, and patient global assessment.
• Osteoporosis: Counseling for Vitamin D and Calcium Intake and Exercise. Percentage of patients, regardless of age, with a diagnosis of osteoporosis who either received both calcium and vitamin D or had documented counseling regarding both calcium and vitamin D intake and exercise at least once within 12 months.
• Gout: Allopurinol Adjustment for Renal Function. If a patient with gout is receiving an initial prescription for allopurinol and has significant renal impairment (defined as a serum creatinine level greater than or equal to 2 mg/dl or measured/estimated creatinine clearance less than or equal to 50 ml/min), then the initial daily allopurinol dose should be less than 300 mg a day.
• Drug Safety: Prophylaxis for Patients at Risk for Gastrointestinal Bleeding. If a patient is treated with 1) a nonselective nonsteroidal anti-inflammatory drug (NSAID) or 2) a COX-2 selective NSAID plus aspirin, and the patient has risk factors for upper gastrointestinal bleeding, then the patient should be treated concomitantly with either misoprostol or a proton pump inhibitor unless the patient refuses.

The RCR, which was demonstrated at the summit, underwent pilot testing this year and will have a limited launch in January 2009. It is slated for a full launch to ACR members by June 2009, says Dr. Solomon. Because CMS will now allow registry in addition to claims-based reporting for PQRI, RCR users will be able to more easily report on measures for the 2009 PQRI incentive payment.