The ACR’s Quality Tools
In an effort to help its members deal with the challenges they face in measuring, improving, and reporting the quality of the care they deliver, the ACR will debut an online management tool called the Rheumatology Clinical Registry (RCR) in early 2009. The RCR will help rheumatologists measure their performance in nearly 20 areas that pertain to rheumatoid arthritis (RA), osteoarthritis, osteoporosis, gout, and drug safety, says Dr. Solomon.
Dr. Solomon acknowledges the challenge that rheumatology faces compared with other specialties, such as cardiology, which can easily use more specific performance-based outcomes. “Quality is hard to define and measure in rheumatology. Pain and function are not as black and white as event-driven [care],” he says. In addition, “much of rheumatology is not strictly evidence based, and the process measures are not always clearly linked to outcomes.”
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.